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THE GROWTH OF MEDICINE FROM THE EARLIEST TIMES TO ABOUT 1800

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Published on the Foundation Established in Memory of

WILLIAM CHAUNCEY WILLIAMS OF THE Class of 1822, Yale Medical School

AND OF

WILLIAM COOK WILLIAMS OF THE Class of 1850, Yale Medical School

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THE GROWTH OF MEDICINE ^

FROM THE EARLIEST TIMES TO ABOUT 1800

By ALBERT H. BUCK, B.A., M.D.

Formerlv Clinical Professor of Diseases of the Ear, Columbia

University, New York — Consulting Aural Surgeon,

New York Eye and Ear Infirmary; etc.

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NEW HAVEN: YALE UNIVERSITY PRESS

LONDON: HUMPHREY MILFORD

OXFORD UNIVERSITY PRESS

MDCCCCXVII

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Copyright, 1917 By Yale University Press

First published, February, 1917

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THE WILLIAMS MEMORIAL PUBLICATION

FUND

The present volume is the first work published by the Yale University Press on the Williams Memorial Publica- tion Fund. This Foundation was established June 15, 1916, by a gift made to Yale University by Dr. George C. F. Williams, of Hartford, a member of the Class of 1878, Yale School of Medicine, where three generations of his family studied — his father, William Cook Williams, in the Class of 1850, and his grandfather, William Chauncey Williams, in the Class of 1822.

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PREFACE

Very few persons will challenge the truth of the state- ment that in the United States and Canada there are not many physicians who possess even a slight knowledge concerning the manner in which the science of medicine has attained its present power as an agency for good, or concerning the men who played the chief parts in bringing about this great result. Up to the present time no blame may justly be attached to any individuals or to any educa- tional institutions for this prevailing lack of knowledge, and for two very good reasons, viz. : first, in a newly settled country, in which the population grows by leaps and bounds through the influx of foreign immigrants, the train- ing of young men for the degree of M.D. must necessarily be almost entirely of a practical character, and conse- quently the teaching of such a subject as the history of medicine would be quite out of place; and, second, the treatises on this subject which are purchasable by English- speaking physicians are of rather too scientific a character to appeal either to the undergraduate or to the busy practitioner. The first of the reasons named, it may now safely be assumed, is rapidly losing its validity, if indeed it has not already ceased entirely to afford a legitimate excuse for neglecting the study of this branch of medical science. On the other hand, the second reason mentioned is still in force, — so far at least as the present writer knows, — and, if such be the case, it certainly cannot fail to act as a deterrent influence of great potency. Here, then, is my apology for attempting to prepare an account of the history of medicine which shall present the essential facts truthfully and with a sufficient degree of attractive- ness to win the continuing interest of the reader; which shall place before him, and especially before those who are just at the threshold of their professional career, word pictures of those physicians of past ages whose lives

X PREFACE

may safely be taken as models worthy to be copied; and which shall describe, so far as I am able to do this, the methods which they employed to advance the science of medicine, to gain genuine professional success, and to merit the enduring esteem of later generations of physi- cians. If my efforts prove successful in producing this kind of history it is fair to expect that, in a comparatively short time, those physicians whose interest may have been aroused by the perusal of this less complete and more popular work, will demand something of a more exhaustive character — a book, for example, like the admirable history which Max Neuburger, of Vienna, is now publishing, and of which two volumes have already issued from the press (the first in 1906 and the second in 1911)/ It is to this work and the excellent history written by the late Dr. Haeser, of Breslau, that I am chiefly indebted for the information supplied in these pages ; and I therefore desire to make special mention here of this indebtedness. The other sources from which I have been an occasional borrower are all mentioned in the ''List of Authorities Consulted." Footnotes and cross-references in the text interfere greatly with one's pleasure in reading a book, and I have therefore not hesitated to introduce them sparingly.

It gives me a special pleasure to call attention here to the far-sighted generosity displayed by the founder of The Williams Memorial Fund in making it practicable henceforth for the Yale University Press to accept for publication medical treatises which deal with the historical and scientific questions of this branch of knowledge, but which for sound business reasons cannot be published on a merely commercial basis.

And I have the further pleasure of expressing my real appreciation of the skill with which the University Press has solved the problems of a suitable size and style of type

1 A third volume is in course of preparation, but the probable date of its publication has not been announced. An English translation of the first volume (by Ernest Playfair) was published by Hodder and Stoughton, of London, in 1910.

PREFACE ' xi

for this volume, and of the sound advice which it has given with regard to the extent to which the effectiveness of the book may be increased by the introduction of pictorial illustrations.

To my friend, Lawrence F. Abbott, of New York, I am deeply indebted for the valuable assistance which he has rendered me throughout the entire progress of this work. Indeed, without this assistance, I doubt whether I should have had the courage to remain at my post to the very end.

Albert H. Buck. Cornwall, N. Y., December 29, 1916.

CONTENTS PART I. ANCIENT MEDICINE

PAGE

Preface ix

Chapter I. Development of the Science and Art of

Medicine ........ 3

Chapter II. Oriental Medicine ..... 13

Chapter III. Oriental Medicine (continued) . . .25

Chapter IV. Greek Medicine at the Dawn of History . 46

Chapter V. The Significance of the Serpent in the Statues and Votive Offerings Exposed to View in the Aesculapian Temples ..... 62

Chapter VI. The Beginnings of a Rational System of

Medicine in Greece ...... 67

Chapter VII. Hippocrates the Great .... 81

Chapter VIII. Brief Extracts from Some of the Hip-

pocratic Writings ...... 89

Chapter IX, The State of Greek Medicine after the Events of the Peloponnesian War; the Founding of Alexandria in Egypt, at the Mouth of the Nile; and the Development of Different Sects in Medicine . 96

Chapter X. Erasistratus and Herophilus, the Two Great Leaders in Medicine at Alexandria; the Founding of New Sects 104

Chapter XI. Asclepiades, the Introducer of Greek Medi- cine into Rome ....... 116

Chapter XII. The State of Medicine at Rome after the Death of Asclepiades; the Founding of the School of the Methodists 129

Chapter XIII. The Further History of Methodism at Rome, and the Development of Two New Sects, viz., the Pneumatists and the Eclectics. — A General Sur- vey of the Subject of Sects in Medicine . . . 138

xiv CONTENTS

PAGE

Chapter XIV. Well-known Medical Authors of the Early

Centuries of the Christian Era .... 151

Chapter XV. Claudius Galen . . . . .160

Chapter XVI. The Influence of Christianity upon the

Evolution of Medicine 179

PART II. MEDIAEVAL MEDICINE

Chapter XVII. The Condition of Medicine at Byzantium

during the Early Part of the Middle Ages . . 191

Chapter XVIII. Beginning of the Arab Renaissance under

the Caliphs of Bagdad . . . . . .203

Chapter XIX. Further Advance of the Arab Renaissance during the Ninth and Succeeding Centuries of the Christiiin Era . . . . . . .212

Chapter XX. Hospitals and Monasteries in the Middle

Ages 235

Chapter XXI. Medical Instruction at Salerno, Italy, in

the Middle Ages 243

Chapter XXII. Early Evidences of the Influence of the Renaissance upon the Progress of Medicine in West- ern Europe ....... 259

Chapter XXIII. Further Progress of Medicine and Sur- gery in Western Europe during the Thirteenth, Fourteenth and a Part of the Fifteenth Centuries . 269

Chapter XXIV. During the Latter Half of the Middle Ages Surgery Assumes the Most Prominent Place in the Advance of Medical Science . . . . 292

Chapter XXV. Brief History of the Allied Sciences —

Pharmacy, Chemistry and Balneotherapeutics . . 315

PART III. MEDICINE DURING THE RENAISSANCE

Chapter XXVI. Important Events that Preceded the Renaissance — Early Attempts to Dissect the Human Body 327

CONTENTS XV

PAGE

Chapter XXVII. The Founders of Human Anatomy and

Physiology ....... 340

Chapter XXVIII. Further Details Concerning the Ad- vance in Our Knowledge of Anatomy. — Dissecting Made a Part of the Regular Training of a Medical Student. — latrochemists and latrophysicists. — The Employment of Latin in Lecturing and "Writing on Medical Topics 355

Chapter XXIX. The Contributions Made by Different Men during the Renaissance, and More particularly by William Harvey of England, to Our Knowledge of the Circulation of the Blood, Lymph and Chyle . 371

Chapter XXX. Advances Made in Internal Medicine and in the Collateral Branches of Botany, Pharmacology, Chemistry and Pathological Anatomy . . . 387

Chapter XXXI. Chemistry and Experimental Pharma- cology ........ 398

Chapter XXXII. Some of the Leaders in Medicine in Italy, France and England during the Sixteenth and Seventeenth Centuries ...... 411

Chapter XXXIII. The Three Leading Physicians of Ger- many during the Latter Half of the Seventeenth Cen- tury: Franz de le Boe Sylvius, Friedrich Hoffmann and Georg Ernst Stahl 426

Chapter XXXIV. Hermann Boerhaave of Leyden, Hol- land, one of the Most Distinguished Physicians of the Seventeenth Century ..... 438

Chapter XXXV. General Remarks on the Development of Surgery in Europe during the Fifteenth and Six- teenth Centuries . . . . . . 446

Chapter XXXVI. Surgery in Germany and Switzerland

during the Fifteenth and Sixteenth Centuries . . 454

Chapter XXXVII. The Development of Surgery in Italy

during the Renaissance ..... 472

Chapter XXXVIII. The Development of Surgery in

Spain and Portugal during the Renaissance . . 484

xvi CONTENTS

PAGE

Chapter XXXIX. The Development of Surgery in France

during the Renaissance. — Pierre Franco . . . 490

Chapter XL. The Development of Surgery in France

(continued). — Ambroise Pare .... 499

Chapter XLI. Surgery in Great Britain during the Six- teenth and Seventeenth Centuries .... 516

Chapter XLII. Reforms Instituted by the Italian Surgeon Magati in the Treatment of Wounds. — Final Ending of the Feud between the Surgeons and the Physicians of Paris. — Revival of Interest in the Science of Obstetrics 529

Chapter XLIII. The First Appearance of Syphilis in Europe as an Epidemic Disease. — Medical Journal- ism.— The Beginnings of a Modern Pharmaco- poeia.— Itinerant Lithotomists .... 542

List of the More Important Authorities Consulted . . 557

General Index ........ 563

LIST OF ILLUSTRATIONS

Fig. 1. View of the Temple of Aesculapius on the Island

of Cos ..... facing page 52

Fig. 2. Bird's-eye View of the Temple of Aesculapius and Associated Buildings on the Island of Cos

facing page 54

Fig. 3. Ground Plan of the Asclepieion on the Island

of Cos ..... facing page 55

Fig. 4. Ancient Statue of the God Aesculapius in the

Berlin Museum .... facing page 62

Fig, 5. Head of the Marble Statue of the God Aesculapius

in the Naples Museum . . facing page 62

Fig. 6. Bas-relief of Aesculapius, Accompanied by- Women and Children, in the Presence of an Enormous Serpent . . . facing page 68

Fig. 7. Female Bust Showing Cancer of One Breast

facing page 68

Fig. 8, Paralysis of the Left Facial Nerve . facing page 70

Fig. 9. The Oldest Known Pictorial Representation of a Formal Dissection of the Human Body

facing page 280

Fig. 10. The Manner of Giving Public Instruction in

Medicine during the Middle Ages . . .281

Fig. 11. Henri de Monde ville . . . facing page 288

Fig. 12. One of the Wards in the Hotel-Dieu of Paris

facing page 304

Fig. 13. The Physician, the Surgeon and the Pharmacist

facing page 306 Fig. 14. Andreas Vesalius . . . . facing page 344

Fig. 15. William Harvey .... facing page 380 Fig. 16. "The Lovesick Maiden" . . . facing page 412

Fig. 17. Thomas Sydenham . . . facing page 418

xvin LIST OF ILLUSTRATIONS

Fig. 18. Consultation by Three Physicians upon a Case

of Wound in the Chest . . . .457

Fig, 19. Barber Surgeon (Wundarzt) Extracting an Arrow from a Wounded Soldier's Chest while the Battle is Still in Progress . . . 461,

Fig. 20. Amputation of the Leg 463

Fig. 21. The Manner in Which the So-called Tagliacotian Operation for Repairing a Defective Nose Should be Carried Out . . . .480

Fig. 22. Pierre Franco's Forceps for Crushing Calculi in

the Urinary Bladder ..... 497

Figs. 23-24. Forceps Devised in 1552 by Ambroise Pare for Drawing Out the Cut Ends of Arteries after the Amputation of a Limb, and Holding Them while the Ligature is Being Applied . . 512

Fig. 25. Ambroise Pare, the Famous French Surgeon of

the Sixteenth Century , . facing page 514

Fig. 26. Frere Jacques de Beaulieu . . facing page 550

Fig. 27. Jean Baseilhac, commonly Known in France as

Frere Come .... facing page 552

Fig. 28. Concealed Lithotome Invented by Frere Come in

1748 553

PART I ANCIENT MEDICINE

CHAPTER 1

DEVELOPMENT OF THE SCIENCE AND ART OF MEDICINE

Friedlaender says that *4n the temple of history, now hoary with age, medicine also possesses its own chapel, not an accidental addition to the edifice but a large and important part of the noble building." In this chapel is preserved the record of the efforts made by man, through the ages, to maintain his body in good condition, to restore it to health when it has become affected by disease or damaged by violence, and to ward off the various maladies to which it is liable. It is a record, therefore, in which every practitioner of medicine should take a deep interest. Rokitansky, the famous pathologist of Vienna, expressed the same idea very tersely when he said: ** Those about to study medicine and the younger physicians should light their torches at the fires of the ancients." Members of the medical profession, however, are not the only persons in the community who take an interest in the origin and growth of the science of medicine and the art of healing the diseased or damaged body ; the educated layman is but little less interested than the physician, being ever ready to learn all he can about the progress of a branch of knowl- edge which so profoundly affects his welfare. But hitherto the only sources of information available for those who are not familiar with French or German have been treatises of so technical a character that even physicians have shown relatively little disposition to read them.

The science of medicine developed slowly from very humble beginnings, and for this earliest period the historian has no records of any kind which may be utilized for his

4 GROWTH OF MEDICINE

guidance. It is reasonably certain, furthermore, that this prehistoric period lasted for a very long time, probably several thousand years; and when, finally, some light on the subject appeared, it was found to emanate from several widely separated regions — e.g., from India, Mesopotamia, Egypt and Greece. Then, after the lapse of additional hundreds or even thousands of years, there was inaugurated the practice of making written records of all important events, and, among others, of the different diseases which affect mankind, of the means employed for curing them or for relieving the effects which they produce, and of the men who distinguished themselves in the practice of this art. While the ''science of the spade" and that of deciphering the writing of the papyri, monuments and tablets thus brought to light, have already during the last half century greatly altered our ideas with regard to ancient medicine, there are good reasons for believing that much additional information upon this subject may be looked for in the not distant future. It is plain, therefore, that a history of the primitive period of medicine, if written to-day, may have to be modified to-morrow in some important respects. On the other hand, the facts relating to the later periods are now so well established that a fair-minded writer should experience no serious difficulty in judging correctly with regard to their value and with regard to the claims of the different men to be honored for the part which each has played in bringing the science and art of medicine to their present high state of completeness and efficiency.

The subdivision of the history of medicine into separate periods is certainly desirable, provided it be found prac- ticable to assign reasonably well-defined limits to the periods chosen. But, when the attempt is made to establish such subdivisions, one soon discovers that the boundaries pass so gradually the one into the other at certain points, or else overlap so conspicuously at other points, that one hesitates to adopt any fixed plan of classification. Of the four schemes which I have examined — viz., those of Daremberg, of Aschoff, of Neuburger, and of Pagel — that of Neuburger seems to me to be the best. That which has

BEGINNINGS OF MEDICINE 5

been adopted, however, in the preparation of the present outline sketch combines some of the features of both the Pagel and the Neuburger schemes.

Periods in the History of Medicine. — There are nine more or less distinctly defined periods in the history of medicine, to wit: —

First Epoch : Primitive medicine. — This period extends through prehistoric ages to a date which differs for different parts of the world. The duration of this period, in any case, is to be reckoned by thousands of years.

Second Epoch: The medicine of the East — that is, of the cultivated oriental races of whose history we possess only a very fragmentary knowledge.

Third Epoch: The medicine of the classical period of antiquity — the pre-Hippocratic period of Greek medicine.

Fourth Epoch : The medicine of the Hippocratic writ- ings— the most flourishing period of Greek medicine.

Fifth Epoch : The medicine of the period during which the centre of greatest intellectual activity was located at Alexandria, Egypt.

Sixth Epoch : The medicine of Galen — an author whose teachings exerted a preponderating influence upon the thought and practice of physicians in every part of the civilized world up to the seventeenth century of the Christian era. This period is also characterized by the gradual diminution of the influence of Greek medicine.

Seventh Epoch: The medicine of the Middle Ages — a period which includes a large part of the preceding epoch. Its most characteristic feature is the important part played by the Arabs in moulding the teachings and practice of the medical men of that time (ninth to fifteenth century).

Eighth Epoch (fifteenth and sixteenth centuries) : The medicine of the Renaissance period — characterized chiefly by the adoption of the only effective method of studying the anatomy of man — the actual dissection of human bodies.

Ninth Epoch (from the beginning of the seventeenth century to the present time) : Modern medicine. — This epoch may with advantage be divided into two periods — the first extending to about the year 1775, soon after which

6 GROWTH OF MEDICINE

time Jenner began Ms important work on the subject of vaccination; and the second to the present time. No attempt will be made in the following account to cover this second period.

The Beginnings of Medicine. — In the early period of man's existence upon this earth he must have possessed an exceedingly small stock of knowledge with regard to the maintenance of his body in health and with regard to the means which he should adopt in order to restore it to a normal condition after it had been injured by violence or impaired in its working machinery by disease. With the progress of time, utilizing his powers of observation and his reasoning faculty, he slowly made additions to his stock of facts of this nature. Thus, for example, he gradually learned that cold, under certain circumstances, is competent to produce pain in the chest, shortness of breath, active secretion of mucus, etc., and his instinct led him, when he became affected in this manner, to crave the local appli- cation of heat as a means of affording relief from these distressing symptoms. Again, when he used certain plants as food he could scarcely fail to note the facts that some of them produced a refreshing or cooling effect, that others induced a sensation of warmth, and finally that others still, by reason of their poisonous properties, did actual harm. Sooner or later, such phenomena as nausea, vomiting and diarrhoea would also be attributed by him to their true causes. In due course of time his friends and neighbors, having made similar observations and having tried various remedial procedures for the relief of their bodily ills, would come together and compare with him their several expe- riences; and so eventually the fact would be brought out that the particular method adopted by one of their number for the relief of certain symptoms had proved more effective than any of the others. Thus gradually this isolated community or tribe of men must have learned how to treat, more or less successfully, the simpler ills to which they were liable.

Lucien Le Clerc quotes from the Arab historian Ebn Abi Ossaibiah the following account of the manner in which

BEGINNINGS OF MEDICINE 7

bloodletting probably first came to be adopted as a remedial measure : —

Let us suppose that in the earliest period of man's history some- body experienced the need of the medical art. He may, for example, have felt a general sense of heaviness in his body (plethora), associated perhaps with redness of the eyes, and he probably did not know what he should do in order to obtain relief from these sensations. Then, when his trouble was at its worst, his nose began to bleed, and the bleeding continued until he experienced decided relief from his discomfort. In this way he learned an important fact, and cherished it in his memory.

On a later occasion he experienced once more the same sense of heaviness, and he lost no time in scratching the interior of his nose in order to provoke a return of the bleeding. The nose- bleed thus excited again gave him entire relief from the unpleasant sensations, and upon the first convenient occasion he told his children and all his relatives about the successful results obtained from this curative procedure. Little by little this simple act, which was a first step in the healing art, developed into the intelligently and skilfully performed operation of venesection.

Primitive man also increased bis stock of knowledge in the healing art by reading attentively the book of nature, — i.e., by observing how animals, when ill, eat the leaves or stems of certain plants and thus obtain relief from their disorders. The virtues of a species of origanum, as an antidote for poisoning from the bite of a snake, were revealed, it is asserted, by the observation that turtles, when bitten by one of these reptiles, immediately seek for the plant in question and, after feeding upon it, experience no perceptible ill effects from the poisonous bite. The natives of India ascribe the discovery of the remarkable virtues of snakeroot (the bitter root of the ophiorrhiza Mungos) as an antidote for poisoning by the bite of a snake, to the ichneumon, a small animal of the rat species. The instinctive desire to escape pain taught man, as it does the lower animals, to keep a fractured limb at rest, thus giving the separated ends of the bone an opportunity to reunite; after which the limb eventually becomes as strong as it ever was. Simple as this mode of acquiring useful medical

8 GROWTH OF MEDICINE

knowledge may appear to us moderns, there are good reasons for believing that hundreds of years must have elapsed before the accumulated stock of such experiences became really considerable. On the other hand, it is reasonable to suppose that this growth in medical knowl- edge took place more rapidly in certain tribes or races than in others, and that when, under the action of wars, the inferior men became tributary to those of greater intel- lectual powers, they acquired, through contact with their conquerors, additional knowledge at a much more rapid rate. One great hindrance, however, stood in the way of such progress. I refer to the deeply rooted belief, enter- tained by man in this primitive period of his existence, in the agency of malevolent spirits (demons) in the production of disease, — a belief which continued to exist for many thousands of years. Out of such a belief developed the necessity of discovering some practical method of appeasing the evil spirits and of thus obtaining the desired cure of the ills of the body. Usually some member of the tribe who had displayed special skill in the treatment of disease, and who at the same time was liberally endowed with the qualities which characterize the charlatan, was chosen to be the priest or ''medicine man." It was his duty to employ measures suitable for expelling the demon from the patient's body and for restoring the latter to health. Possessing great influence, as these superstitious people believed he did, with the unseen gods, such a physician- priest must have discouraged all efforts to increase the stock of genuine medical knowledge; for such an increase would necessarily mean a diminution of his own power and influence.

In what must still be termed the age of primitive medi- cine, but undoubtedly at an advanced stage of that epoch, there were performed surgical operations which imply a remarkable advance in the invention of cutting instruments and in the knowledge of the location and nature of certain comparatively rare diseases, and at the same time great courage and wonderful enterprise on the part of those early physicians. As evidence of the correctness of these

BEGINNINGS OF MEDICINE 9

statements the fact may be mentioned that trepanned skulls belonging to the neolithic period have been dug up in various parts of the world — in most of the countries of Europe, in Algiers, in the Canary Islands, and in both North and South America. From a careful study of these skulls it has been learned that the individuals upon whom such severe surgical work had been done — sometimes as often as three separate times — recovered from the opera- tion. The instruments used were made of sharpened flint (saws or chisels). Pain in the head, spasms or convulsions, and mental disorders are suggested by Neuburger as the indications which probably led to the performance of the trepanning. This author also makes the further statement that the ancient Egyptians employed knives made of flint for opening the dead bodies which they were about to embalm and for the operation of circumcision. Recent excavations have thrown additional light upon the state of medical knowledge during this neolithic age. Thus, there have been found specimens of anchylosed joints, of fractured bones, of flint arrow heads lodged in different parts of the skeleton, of rhachitis, of caries and necrosis of bone, etc. The following quotation is taken from the printed report of a lecture recently delivered in London by Dr. F. M. Sandwith, Consulting Surgeon to the Khedive of Egypt. Speaking of certain excavations made in the Nubian Desert and of the oldest surgical implements yet discovered, he says : —

In one place a graveyard was found, and here were remains of bodies with fractured limbs that had been set with bark splints. One was a right thigh bone that had been broken, and was still held in position by a workmanlike splint and bandages. All the knots were true reef-knots, and the wrappings showed how the strips of palm-fibre cloth were set just as a good surgeon would set them in these days so as to use the full strength of the fabric.

Among the most ancient remedies may be mentioned talismans, amulets and medicine stones, which were fur- nished— presumably at a price — by the physician-priests, and which were believed to afford the wearers protection

10 GROWTH OF MEDICINE

against evil spirits (the **evil eye," for example). Various objects were used for this purpose, and among them the following deserve to be mentioned : disks of bone removed with the aid of a trephine from the skull of a dead human body and worn with a string around the neck ; the teeth of different animals; bones of the weasel; cats' claws; the lower jaw of a squirrel; the trachea of some bird; one of the vertebrae of an adder, etc. And where these measures failed, the priests resorted to incantations, religious dances, and the beating of drums or the rattling of dried gourds filled with pebbles. Primitive races of men inhabiting the most widely separated parts of the earth appear to have adopted means almost identical with those just described for driving away evil spirits. The holding of these super- stitious beliefs is one of the most extraordinary character- istics of the human race. It played an important part throughout the classical period of Greek and Eoman civilization, and also during the Middle Ages. Christianity undoubtedly was a most potent agency in hastening the eradication of the feeling, but even this great power has not yet sufficed entirely to do away with superstition; for traces of this weakness may still easily be detected in some of the men and women with whom we daily come in contact.

CHAPTEK II ORIENTAL MEDICINE

The researches of the scholar working in combination with the engineer have unearthed — ^more particularly in Mesopotamia, in Egypt and in Greece — evidences of an ancient medical science far advanced beyond that briefly described in the preceding chapter. These evidences relate to nations that flourished as far back as four thousand years B. C. While they are very fragmentary and cover historical events which are often separated from one another by long periods of time, these data nevertheless suffice to give one a fairly good idea of the then prevailing state of medical knowledge. Both Pagel and Neuburger adopt the plan of discussing these different nationalities separately, and I shall follow their example.

Medicine in Mesopotamia. — As appears from the most recent investigations the Sumerians were the first occu- pants of the region lying between the Euphrates and the Tigris rivers. It was from them that their Semitic con- querors, the Babylonians and the Assyrians, received a civilization which, already about 4000 B. C, had reached a wonderful degree of development. The canalization of the low-lying lands of that 'region, the organization of a religious and civil government of a most efficient type, the invention first of picture-writing and then of the cuneiform characters, the cultivation of the arts and natural sciences and especially of astronomy and mathematics to a high degree of perfection, — these are among the things which were accomplished by this very clever race of men. In addition, however, to these useful activities the Babylo- nians developed and cultivated diligently the science of astrology — that is, the science of predicting human events

12 GROWTH OF MEDICINE

(such as the death of the king, the occurrence of the plague or of war, etc.) from various telluric and cosmic phe- nomena— an eclipse of the sun, peculiarities of the weather, the condition of vegetation, etc. The deeply- rooted love of the human race for the supernatural — a characteristic to which I have already briefly referred — facilitated the development of this harmful practice, and kept it alive through many succeeding centuries. Walter Scott, in his romance entitled Quentin Durward, gives an admirable portrait of a typical astrologer whom Louis XI. of France maintained at his court during a part of the seventeenth century.

While in other parts of the Orient the science of medi- cine, as already stated at the beginning of this chapter, made a noteworthy advance beyond the conditions observed among the primitive races, in Mesopotamia this science, which was far more important to the welfare of its inhabi- tants than all the other branches of knowledge combined, received very little attention and consequently made only insignificant advances. The British Museum has in its possession several thousand tablets which were dug up from the ruins of Nineveh and which represent a part of the library of the Assyrian King, Assurbanipal (668-626 B. C). Translations of the text of only a very few of these tablets have thus far been published, and from these, which embody the greater part of our knowledge of Assyrian medicine, it appears that, for the present at least, the estimate recorded above must stand. A few new facts, however, have been brought to light, and they appear to be of sufficient importance to merit brief consideration here.

In the first place, Herodotus, who visited Babylon about 300 B. C, has this to say in relation to the state of medicine in that city: —

The following custom seems to me the wisest of their institutions next to the one lately praised. They have no physicians, but, when a man is ill, they lay him in the public square, and the passers-by come up to him, and if they have ever had his disease themselves or have known any one who has suffered from it, they give him advice, recommending him to do whatever they found good in their

ORIENTAL MEDICINE 13

own case, or in the case known to them; and no one is allowed to pass the sick man in silence without asking him what his ailment is.^

The Babylonians held some rather strange beliefs regarding the construction of the human body and the manner in which its functions are performed. The living being, as they maintained, is composed of soul and body. The intellect has its seat in the heart, the liver serving as the central organ for the blood, which they considered to be the true life principle. They divided this fluid into two kinds — blood of the daytime (bright arterial) and that of the night (dark venous). Although the blood was held by them to be the basis of life, they evidently attached a certain value to respiration, for one of their prayers begins with these words : * * God, my creator, lead me by the hand ; guide the breath of my mouth. ' * Disease was always looked upon as something (usually personified as a demon) that entered the body from without and that consequently had to be expelled. There were special demons for the different diseases. Thus, Asakku brought fever to the head, Namtar threatened life with the plague, and Utukku attacked the throat, Alu the breast, Gallu the hand, Rabisu the skin, and so on. The most dreaded demons were the spirits of the dead. Special amulets were employed as protective remedies. Prayer formulae were also used. Here is one among several that I find mentioned in Neuburger's treatise : —

Wicked Consumption, villainous Consumption, Consumption which never leaves a man, Consumption which cannot be driven away, Consumption which cannot be induced to leave. Bad Consumption, in the name of Heaven be placated, in the name of Earth I conjure thee !

The genuine remedial agents employed in Babylonia were of a most varied nature: a mixture of honey and syrup of dates; medicinal herbs of different kinds for internal administration; bloodletting; the use of cups for drawing blood to the surface of the body ; warm baths and

1 Book I,, section 197, of Eawlinson's translation.

14 GROWTH OF MEDICINE

cold shower baths; rubbing oil over the body; medicated clysters; the use of various salves; the use of secret remedies which were composed of various ingredients and which bore such names as *'the Sun God's remedy," **the dog's tongue," "the skin of the yellow snake," ''the medicine brought from the mountain of the human race," etc.

Some of the predictions made by the Babylonian astrolo- gers are of sufficient interest to be placed on record. Here are a few examples : —

If the west wind is blowing when the new moon is first seen, there is hkely to be an unusual amount of illness during that month.

If Venus approaches the constellation of Cancer, there will be respect for law and prosperity in the land; those who are ill will recover, and pregnant women will have easy confinements.

If Mercury makes its appearance on the fifteenth day of the month, there will be corpses in the land. And again, if the con- stellation of Cancer is obscured, a destructive demon will take possession of the land, and there will be corpses.

If Jupiter and the other planets stand opposite one another, some calamity will overtake the land. If Mars and Jupiter come into conjunction, there will be deaths among the cattle.

If an eclipse of the Sun take place on the twenty-eighth day of the month I jar, the king will have a long reign ; but, if it take place on the twenty-ninth day of the month, there will be corpses on the first day of the following month.

If there should be thunder during the month of Tisri, a spirit of enmity will prevail in the land ; and if it should rain during that month, both men and cattle will fall ill.

Besides these predictions, which were based upon phe- nomena connected with the movements of the stars and the conditions of the weather, there were others which the people themselves were competent to make without the aid of the professional astrologer or the official priest. Such, for example, are the following ** omens": —

If a woman gives birth to a child the right ear of which is lacking, long will be the reign of the prince of that land.

If a woman gives birth to a child both of whose ears are lacking,

ORIENTAL MEDICINE 15

sadness will come upon the land and it will lose some of its importance.

If a woman gives birth to a child whose face resembles the beak of a bird, there will surely be peace in the land.

If a woman gives birth to a child the right hand of which lacks fingers, the sovereign of that country will be taken prisoner by his enemies.

The keen interest taken by the priests in the matter of predicting the outcome of various diseases led in due time to their making records of the nature, symptoms and progress of the latter. Although this practice was inaugu- rated purely for the purpose of enabling them to foretell with greater accuracy the probable issue of any given malady, it nevertheless served also to establish on a firm basis the custom of keeping records of the case-histories. Only one thing more was now needed to render this practice the first step in a genuine advance of medical knowledge; but this step could not be made in Babylonia, where priestcraft and superstition had struck such deep roots in the public life. It was only in free Greece, and at a time in its history when the spirit of Hippocrates exerted an overpowering influence over the minds of men, that the separation of the functions of the physician from those of the priest became possible and was in due time effected. (Neuburger.)

Before closing this very incomplete account of the state of medical knowledge in Babylonia, it will be well to mention some of the items of the law laid down by Hammurabi (circa 2200 B. C.) for the guidance of the physicians of that land with regard to the remuneration which they should receive. At the same time I shall make no attempt to reconcile the statement of Herodotus (given on page 12) with the wording of this law, which distinctly recognizes the existence of physicians in Mesopotamia. Possibly the conditions in Nineveh in the fourth century B. C. were different from what they had been eighteen centuries earlier.

If a physician makes a deep cut with an operating knife of bronze and effects a cure, or if with such a knife he opens a tumor

16 GROWTH OF MEDICINE

and thus avoids damaging the patient's eye, he shall receive as his reward 10 shekels of silver. If the patient is an emancipated slave, the fee shall be reduced to 5 shekels. In the case of a slave the master to whom he belongs shall pay the physician 2 shekels.

If a physician makes a deep wound with an operating knife of bronze and the patient dies, or if he opens a tumor with such a knife and the patient 's eye is thereby destroyed, the operator shall be punished by having his hands cut off.

If a physician, in operating upon the slave of a freedman, makes a deep wound with an operating knife of bronze and thus kills the patient, he shall give the owner a slave in exchange for the one killed. And if, in opening a tumor with such a knife, the physician destroys the slave's eye, he shall pay to the latter 's owner one-half the slave 's value.

If a physician effects the healing of a broken bone or cures a disease of the intestines, he shall receive from the patient a fee of 5 shekels of silver.^

It would be difficult to imagine anything better adapted to arrest the development of medical knowledge in a nation than the promulgation of a law like that ascribed to Hammurabi ; and one cannot be surprised at the statement made by Herodotus, eighteen centuries later, ''that there were no physicians in Babylon. ' ' Foolhardy, indeed, would be the man who, for the sake of earning a possible reward of six shekels of silver, would be willing to risk the danger of having both his hands cut off; and yet every conscien- tious and faithful practitioner of medicine in Babylon at the time mentioned must necessarily have been obliged to run this risk.

Medicine in Ancient Egypt. — Of the sources of informa- tion with regard to the knowledge of medicine possessed by the ancient Egyptians the most important are the following: Homer's Odyssey; Herodotus; Diodorus; Clemens of Alexandria; Pliny's Natural History; Dioscori-

2 From the statements just quoted it appears that a certain kind of bronze (an alloy of copper and tin, with the addition perhaps of a little zinc) was used in Assyria, in the manufacture of surgical knives, as early as during the twenty-third century B. C. Dr. Meyer-Steineg, Professor of the History of Medicine in the University of Jena, Germany, assures the writer that knives made of this material are susceptible of being given as keen a cutting edge

ORIENTAL MEDICINE 17

des; the Papyrus Ebers; the Papyrus Brugsch; and the Papyrus Birch, in the British Museum. Then, in addition to these sources, there are the inscriptions found in recent times on the walls of the temples and the pictures painted on the wrappings of mummies, from both of which consid- erable information with regard to various therapeutic procedures and to the details of the process of embalming Has been derived. Some of this information extends back to about 3000 B. C. The healing art was at that time entirely in the hands of the temple priests, who formed an organized body with a sort of physician-in-chief at its head. Two of these — Athotis and Tosorthos — attained such a high standing and possessed such influence that they were chosen Kings of Egypt. The practice of obstetrics was entrusted to the care of women who had been trained to this work and who acknowledged the authority of a skilled head-nurse of their own sex. The patients who had received treatment for their ailments at one or other of the temples presented to these institutions gifts in the form of sculptured or painted representations of the diseased or injured parts of the body. In these and in other ways medicine and pharmacy received contributions which were of no mean value. Botanical gardens were established at various places in Egypt and were cultivated with care. Chem- istry— a name which derives its origin from a word in the Egyptian language — also made considerable progress as a science. On the other hand, the knowledge of the structure and functions of the different parts of the human body was very imperfect and remained unchanged for many centuries. This would probably not have been the case if the work of preparing the bodies for the process of embalming had not been entrusted entirely to mere menials, men who had no interest in anything but the mechanical part of their occupation.

According to the statement of Clemens of Alexandria'

as are those made of the best of steel. At least one such bronze knife may be seen in the collection of ancient surgical instruments, votive offerings, etc., which he is making for the benefit of the University.

8 A Christian ecclesiastical writer who lived about the year 200 A. D.

18 GROWTH OF MEDICINE

the Egyptian science of medicine is set forth in the last six of the forty-two hermetic books, which were composed, according to the prevailing belief, by the god Thot or Thoiit (= Hermes of the Greeks). The first one of these six books is devoted to the anatomy of the human body, the second one to the diseases to which it is liable, the third to surgery, the fourth to remedial agents, the fifth to the diseases of the eye, and the sixth to diseases of women. As to the remedial agents, Neuburger says that it has not been found practicable to identify more than a very few of the Egyptian drugs enumerated by Dioscorides. Homer, who wrote at least five hundred years B. C, has something to say on this subject in the Odyssey.* His words are as follows : —

Such drugs Jove's daughter owned, with skill prepar'd,

And of prime virtue, by the wife of Thone,

Aegyptian Polydamna, given her.

For Aegypt teems with drugs, yielding no few

Which, mingled with the drink, are good, and many

Of baneful juice, and enemies to life.

There every man in skill medicinal

Excels; for they are sons of Pason^ all.

A physician of the present age, on reading the histories of the ancient Egyptians, Greeks and other oriental nations, finds it almost impossible to realize that many of the characters designated as gods and goddesses, possibly all of them, were not mythological persons, as they would have been termed only a few years ago, but real human beings like ourselves. Such, for example, was the opinion of Cicero who, when asked why these people were spoken of as gods, gave the following reply :^ *'It was a well- established custom among the ancients to deify those who had rendered to their fellow men important services, as

4 Lines 285-292 of Book IV. of the Earl of Derby's translation, first pub- lished in 1864.

5 Pason is the same as Apollo, who was believed by the Greeks to have been the inventor or discoverer of the art of medicine.

• See Le Clerc 's Histoire de la Medecine, Amsterdam, 1723.

ORIENTAL MEDICINE 19

Hercules, Castor and Pollux, Aesculapius, Bacchus and many others had done.'* And I find that those modern authors of the history of medicine whose works I have consulted, are quite ready to accept even the gods called by the Egyptians Osiris (or Serapis), Isis, and Thoiit (or Hermes) as genuine historical personages. Such a belief receives some degree of confirmation from the following inscriptions which, according to the authority of Le Clerc,^ were found engraved upon two columns dis- covered in the city of Nyoa, in Arabia : —

(On the first column) : My father is Cronos, the youngest of all the gods. I am King Osiris, who have visited with my armies every country on the face of the earth — the remotest inhabitable parts of India, the regions lying beneath the Bear, the neighbor- hood of the sources of the Danube, and the shores of the Ocean. I am the oldest son of Cronos, the scion of a fine and noble race. I am related to the day. There is no part of the earth which I have not visited, and I have filled the entire universe with my benefits. (On the second column) : I am Isis, Queen of all this country, and I have been taught by Thoiit. There is nobody who has the power to loosen what I shall bind. I am the oldest daughter of Cronos, the youngest of the gods. I am the wife and at the same time the sister of King Osiris. To me is due the credit of having been the first to teach men agriculture. I am the mother of King Horus. I shine in the dog-star. It is I who built the city of Bubastis. Farewell, Egypt, my native land.

The discovery of the art of medicine, says Le Clerc, was attributed to Osiris and Isis, and they were also credited with having taught it to Aesculapius.

At the cities of On (Heliopolis), Sais, Memphis and Thebes were located the most celebrated of the Egyptian temples, which were dedicated not merely to the worship of their numerous gods, but also to the dissemination of knowledge of various kinds and to the care of the sick and maimed. In a word, they were — like the Aesculapian temples at Trikka, Epidaurus and Cos, of which some account will be given farther on — both hospitals for the

T At bottom of p. 15 of his Riatoire de la Midecine.

20 GROWTH OF MEDICINE

treatment of disease and schools for the training of physicians. The chief priest of the temple bore also the title of the *' physician-in-chief , " and exercised the pre- rogatives of a chief magistrate. Under this system medical knowledge advanced to a certain stage and then made no further progress. The preponderance of the priestly {i.e., the superstitious) influence was too pronounced to permit anything like real progress.

The papyrus Ebers makes mention of a number of dis- eases, and among them the following may be noted : abdomi- nal affections (probably dysentery), intestinal worms, inflammations in the region of the anus, hemorrhoids, painful disorders at the pit of the stomach, diseases of the heart, pains in the head, urinary affections, dyspepsia, swellings in the region of the neck, angina, a form of disease of the liver, about thirty different affections of the eyes, diseases of the hair, diseases of the skin, diseases of women, diseases of children, affections of the nose, ears and teeth, tumors, abscesses and ulcers.

In the matter of diagnosis the Egyptian physicians not only employed inspection and palpation, but were in the habit of examining the urine. A statement made in the papyrus Ebers is good ground for the belief that they also employed auscultation to some extent.

Therapeutics constituted beyond all question the strong- est part of Egyptian medicine. As might be expected from the strange mixture of the priest and the medical man in every physician, the remedial measures commonly employed consisted in part of prayers and incantations, and in part of rational procedures and the use of drugs. Among the latter class of remedies the following deserve to be mentioned: emetics, cathartics and clysters. Bloodletting, sudorifics, diuretics and substances which cause sneezing were also often employed in Egypt. To produce vomiting the favorite agents were the copper salts and oxymel of squills. Castor oil disguised in beer was given as an aperient. Pome- granate was the drug preferred for the expulsion of worms. Mandragora and opium were also employed as remedies. Foreign drugs were largely imported by the Phoenicians,

ORIENTAL MEDICINE 21

and in their successful campaigns against Asiatic nations the Egyptians learned much about the use of these rarer remedies. The different forms in which the Egyptians administered their remedies included potions, electuaries, gums to be chewed but not swallowed, gargles, snuffs, inhalations, salves, plasters, poultices, injections, supposi- tories, clysters and fumigations. The physicians, in their practice, were subjected to very strict rules regarding the amount of the doses to be given and the manner of admin- istering the different remedies, and consequently they received no encouragement to indulge in any individuality of action. The prescriptions were written in very much the same manner as are those of to-day; that is, they contained the fundamental or important drugs, certain accessory materials, and something which was intended merely to correct the unpleasant taste of the mixture. In comparison with those commonly written at a somewhat later period these ancient prescriptions were of a very simple character.

Up to the present time the researches of the archaeolo- gists have thrown comparatively little light on the surgery of the ancient Egyptians. The facts already ascertained, however, are sufficient to warrant the statement that they had reached a degree of knowledge and skill in this depart- ment of medicine well in advance of that reached by any of their contemporaries. They performed the operations of circumcision and castration, and they removed tumors, and their eye surgeons were especially renowned for the work which they accomplished in their special department. Their skill in manufacturing surgical instruments is amply revealed in the specimens — instruments for cupping, knives, hooks, forceps of different kinds, metal sounds and probes, etc. — ^which have been dug up at the various sites of ancient ruins. They must also have possessed consid- erable manual skill, for without it they could not, in embalming a corpse, have removed the entire brain from the skull with a long hook, by way of the nasal passages, and at the same time have left the form of the face undisturbed.

22 GROWTH OF MEDICINE

From Joachim's German translation of the papyrus Ebers,* as quoted by Neuburger, I copy the following passages : —

If thou findest, in some part of the surface of a patient's body, a tumor due to a collection of pus, and dost observe that at one well-defined spot it rises up into a noticeable prominence, of rounded form, thou should 'st say to thyself: This is a collection of pus, which is forming among the tissues ; I will treat the disease

with the knife If thou findest, in the throat of a patient,

a small tumor containing pus, and dost observe that it presents at one point a well-defined prominence like a wart, thou may'st conclude that pus is collecting at this point. ..... If thou findest,

in a patient's throat, a fatty growth which resembles an abscess, but which yields a peculiar sensation of softness under the pressure of the finger, say to thyself: this man has a fatty tumor in his throat ; I will treat the disease with the knife, but at the same time I will be careful to avoid the blood-vessels.

These short extracts will suffice to show that the Egyptian physicians of that early period — at least 1550 B. C. — reasoned about pathological lesions in very much the same manner as a physician of to-day would reason. In this same ancient papyrus, however, foolish as well as sensible statements appear. Thus, for example, mention is made on the one hand of the fact that, in order to give a certain remedy to an infant, it is sufficient to administer it to the nurse who suckles the child (a proceeding which is not uncommon in our own day) ; and then, in another part of the text, it is stated that ^*if, on the day of its birth, the infant does^ ^not cry, it will surely live ; but, if it says * ba, * it will die. 'J

In matters relating to personal hygiene the ancient Egyptians often displayed a remarkable degree of common sense. They maintained, for example, that the majority of diseases are due to the taking of food in excessive quantity ; and, in harmony with this belief, they introduced the custom of devoting three days out of every thirty to the taking of emetics and clysters. Perhaps it was to this

8 Papyros Ebers, aus dem Aegyptischen zum ersten Male vollstandig uber- setzt von H. Joachim, Berlin, 1890.

ORIENTAL MEDICINE 23

custom that they owed their good health, — a fact to which both Herodotus and Diodorus testify. In principle this practice agrees with that adopted by modern physicians, who omit the emetics and substitute for the clysters the drinking of certain mineral waters during a limited period of the summer season and under the very agreeable surroundings of a comfortable hotel at Carlsbad, Ems, Wiesbaden or Saratoga. While the monthly plan of purging the system of harmful elements must certainly have been the more effective of the two, it cannot for a moment be doubted that exceedingly few moderns would be willing to subject themselves to such a regime.

In still other ways the ancient Egyptians displayed a most intelligent respect for every measure that tended to promote the general health of the community. They took care, for example, to prevent the entrance of decomposing materials into the soil and the ground water ; priests skilled in work of this character made careful inspections of all meats that were to be used for food ; stress was laid upon the importance of keeping the dwelling houses clean; the people were taught the value of bathing the body frequently, of cultivating gynmastic exercises, of clothing themselves suitably, and of employing the right sort of diet. At a still later period of their history they adopted the custom of drinking only water that had been either boiled or filtered. A particular kind of beer, the gift of their first king, Osiris, was the favorite beverage of the people. It was made from barley and doubtless possessed intoxicating properties, as is suggested by one of the papyrus texts in which the following charge is brought against a student: **Thou hast abandoned thy books and art devoting thyself to idle pleasures, going from one beer-house to another. Thou smellest so strongly of beer that men avoid thee."

A large proportion of the sources of information regard- ing the medicine of the ancient Egyptians have been brought to light during recent years, but so many gaps in the series still remain unfilled that it is not possible to furnish more than a disconnected and very imperfect account. Archaeological investigations, however, are being

24 GROWTH OF MEDICINE

conducted with vigor and new discoveries are reported almost every month. There are therefore good reasons for hoping that, in the course of the next few years, much additional light will be shed on the mode of life and accomplishments of these pioneers of civilization, who, before they passed out of history, succeeded in attaining the highest degree of cultivation in the science and art of medicine that had up to that time been attained by any other nation. One thing is certain, says Neuburger, they exerted a powerful influence upon the beginning of medicine in Greece and upon the social hygiene of the Jewish people, and therefore upon the human race at large.

CHAPTER III ORIENTAL MEDICINE (Continued)

The Medicine of the Ancient Persians. — ^After Cyrus the Great had put an end to Babylon as a power among the nations the Persians became the leaders in all the affairs not merely of Asia Minor but also of the entire country from India to the shores of the Mediterranean; in fact, they eventually also gained control of the land of the Pharaohs. Notwithstanding the completeness of the political power which they possessed over these conquered races, they permitted them to retain their respective religions and even their individual languages ; as evidence of the correctness of which last statement the modern discovery of inscriptions written in the three principal tongues may be mentioned. The remarkable degree of general culture which existed at Babylon at the time of the Persian conquest, and which the Sumerians and Semites had originally introduced, was left undisturbed by the political change.

So far as we possess any knowledge regarding the medicine of the ancient Persians, this information has been derived, according to Neuburger, from the Zend-Avesta — one of the ancient religious writings preserved by the Parsees. It furnishes comparatively few facts of special interest to physicians. In the main, the practice of medi- cine must have differed very little from that employed by the earliest Babylonian physicians, and briefly described on pages 11-16. There are one or two additional matters, however, which deserve to be mentioned here. It was maintained, for example, that the touching of a corpse produced a special contamination, a belief which interfered most seriously with the study of anatomy, and therefore

26 GROWTH OF MEDICINE

prevented any real advance in medical knowledge. Then, again, the ancient Persians appear to have taken compara- tively little interest in surgery, for it is said that King Darius I. was obliged, when he needed treatment for a badly sprained ankle, to send for a Greek physician. Finally, there may be found in Herodotus the following statement, which shows that the Persians had learned something of value, in practical hygiene, from their neighbors, the Egyptians: —

The Great King (Cyrus), when he goes to the wars, is always supplied with provisions carefully prepared at home, and with cattle of his own. "Water, too, from the river Choaspes, which flows by Susa, is taken with him for his drink, as that is the only water which the kings of Persia taste. "Wherever he travels, he is attended by a number of four-wheeled cars drawn by mules, in which the Choaspes water, ready boiled for use, and stored in flagons of silver, is moved with him from place to place.^

Neuburger makes the remark that the ancient Persians are entitled to the gratitude of later generations for the valuable service which they rendered the science of medi- cine, inasmuch as, during the dynasty of the Sassanide princes (fifth century A. D.) and at a time when European culture was hastening to its destruction, they gave shelter both to classical culture in general and to the medical knowledge of the Greeks, and then afterward handed it over to the conquering Arabs, who passed it on to our forefathers.

The Medicine of the Old Testament. — There are no medical writings which give any information concerning the science and art of medicine as possessed by the ancient Israelites, but the Bible contains a number of passages that refer to matters which belong in the domain of medicine, and more particularly in that of social hygiene. The mosaic laws were framed with a view to the good of the Jewish people as a whole, and were directed to such matters as the prevention and suppression of epidemic diseases, the combating venereal affections and prostitution, the care

1 Book I., p. 96, of George Eawlinson 's translation.

ORIENTAL MEDICINE 27

of the skin, the systematizing of work, the regulation of sexual life, the intellectual cultivation of the race, the provision of suitable clothing, dwellings and food, the use of baths, etc. Many of these laws — like those, for example, which prescribe rest on the Sabbath day, circumcision, abstinence from eating the flesh of the pig, the isolation of persons affected with leprosy, the observation of hygienic rules in camp life, etc. — testify to a remarkably high degree of the power to reason correctly; and, when considered in the light of modern science, they seem to justify the pre- diction made in Deuteronomy iv., 6. A similar prediction (supposed to be spoken by God from Mount Sinai) is made in Exodus xix., 6: ''And ye shall be unto me a kingdom of priests, and an holy nation. ' ' That a large part of the credit given to Moses for the wisdom displayed in these sanitary laws really belongs to the Egyptians is shown by the text of Acts vii., 22: ''And Moses was learned in all the wisdom of the Egyptians, and was mighty in words and in deeds."

As regards the manner in which the Israelites treated the diseases which afflicted them the Bible furnishes ample proof of the fact that they placed their chief reliance upon prayers, sacrifices, and offerings at their temples, and made comparatively small use of medicinal agents, dietetic measures, and external applications. The favorable effect of David 's harp-playing upon the melancholia of King Saul furnishes the only instance, to be found in the Bible, of the curative value of music in certain mental disorders.

The story of Naaman (2 Kings v.) deserves to be mentioned briefly here. He was captain of the host of the King of Syria (about 894 B. C.) and a man of valor, highly esteemed by his master, but he was — according to the Bible statement — a leper. Learning casually that there was in Samaria a prophet who might be able to cure his disease, he put a large sum of money into his sack and departed for that country. "So Naaman came with his horses and with his chariot, and stood at the door of the house of Elisha. And Elisha sent a messenger unto him, saying. Go and wash in Jordan seven times, and thy flesh shall come again

y~

28 GROWTH OF MEDICINE

to thee, and thou shalt be clean." Naaman, at first much displeased with the advice given to him by Elisha, and especially by the very informal manner in which it had been communicated to him, finally decided to follow the prophet's instructions. *^Then went he down, and dipped

himself seven times in Jordan, and his flesh came

again like unto the flesh of a little child, and he was clean.

And he returned to the man of God, and came, and

stood before him; and he said. Behold, now I know that there is no God in all the earth, but in Israel: now there- fore, I pray thee, take a blessing of thy servant." Elisha, however, refused persistently to accept any reward for the advice which he had given. He simply said to Naaman: **Go in peace." Before he departed, however, Naaman expressed to Elisha the hope that he would be pardoned if he yielded to the necessity of bowing down to the god Rimmon on certain occasions — as, for example, when he accompanied his master, the king, on his visits to the temple of that god for the purposes of worship. From the evidence furnished by this account, as given in the Old Testament, it is fair to assume that both Naaman and the writer of the book of Kings believed that the cure had been effected by supernatural means. The modern physician, however, is not ready to accept such an interpretation of the manner in which Naaman 's cure was effected, but prefers to believe that the supposed leprosy was in reality some curable form of skin disease which to the unprofes- sional eye appeared like the other malady. It might, for example, have been an aggravated general eczema, depend- ent upon such excesses of eating and drinking as a wealthy captain of the king's host would be likely to indulge in. And if this supposition is correct, one cannot but admire the great practical wisdom of Elisha in advising Naaman to take seven baths — one a day presumably — in the river Jordan, a spot so far removed from his home that it would scarcely be possible for him to obtain any but the simplest kind of diet during this comparatively long period of time. An interesting case of snake-bite is briefly related in Acts xxviii., 3-6. It is stated that ''when Paul (after being

ORIENTAL MEDICINE 29

shipwrecked on the Island of Melita) had gathered a bundle of sticks, and laid them on the fire, there came a viper out of the heat, and fastened on his hand. And when the barbarians saw the venomous beast hang on his hand, they said among themselves, No doubt this man is a murderer, whom, though he hath escaped the sea, yet vengeance suffereth not to live. And he shook off the beast into the fire, and felt no harm. Howbeit they looked when he should have swollen, or fallen down dead suddenly : but after they had looked a great while, and saw no harm come to him, they changed their minds, and said that he was a god.'* This narrative is interesting in several respects, but there is one feature that deserves to receive special mention, viz., the fact that Paul experienced no harm from the bite of a poisonous serpent — a wound which frequently proves fatal. Inasmuch as the account distinctly states that the reptile ** fastened on his hand" and that *Hhe barbarians saw the venomous beast hang on his hand," the conclusion is war- ranted that one or both of the creature 's fangs had entered the hand by a curving route, and probably in such a manner that the free end of each fang, from which the poison is ejected, passed completely through the skin from within outward. When the bite of a poisonous snake is of a character such as I have just described, — and not a few of them have this character, — only a very small quantity of the venom is lodged in the subcutaneous tissues, where the larger blood- and lymph-channels lie, and as a conse- quence the person bitten escapes serious harm. On the other hand, when the fangs enter the flesh in a less decidedly curving direction, thus permitting a greater quantity of the venom to reach and remain in the deep-lying tissues, serious or even fatal results may be anticipated. The point, then, which I desire to make is simply this: Paul's escape from death in this instance may perfectly well be ascribed to natural causes.

The Israelites, at a certain stage of their history, appear to have completely divorced the practice of medicine from the priestly function. In one place, for example, it is stated that King Asa sought relief from his ailment, not from

30 GROWTH OF MEDICINE

Jehovah, but from the physicians. Jeremiah expresses astonishment that not a single physician is to be found in Gilead. May this not be interpreted as signifying that regularly established physicians were at that time (595 B. C.) to be found in some parts of Palestine? And, at a much earlier period (1500 B. C), Job calls his friends ''physicians of no value" (Job xiiL, iv.). From these and a number of other statements in the Bible it seems per- missible to believe that, at a very early period of history, the Jewish physicians occupied an entirely independent position.

It would doubtless appear strange to most readers of this brief sketch of the history of medicine if some refer- ence were not made in this place to Luke, the author of the gospel which bears his name and of the Acts of the Apostles, and who was also the companion of Paul on his journey to Rome and during a portion of the latter 's stay in that city. Luke was a native of Antioch, in Syria, and not a Jew. He was a physician and tradition says that he was also a painter. It is not known where he received his medical training, but it is not at all unlikely that he studied at Alexandria, in Egypt, where the greatest facilities for such training, obtainable at that period, were to be found. His style of writing shows plainly that he was a man of considerable cultivation and endowed with a clear and logical mind ; and if he had not possessed a genial person- ality he would hardly have been known as "the beloved physician"; nor could any other motive but those of loyal, self-sacrificing friendship for his friend, and a desire to promote the cause of Christianity, have led him to share with Paul the dangers and discomforts of the journey to Rome.

The Medicine of India, China and Japan. — It would be too much of a departure from the plan which is being followed in the writing of this history to attempt to describe, even in the briefest manner, the mode of develop- ment of the science and art of medicine in India, China and Japan. Unquestionably the earlier physicians of these countries made many valuable contributions to

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medical knowledge, but they were made at such a period of time, or under such conditions, that they could not have exerted an appreciable influence upon the development of medicine in ancient Greece, — certainly no such influence as was exerted by Assyria and Persia, and especially by Egypt. It therefore seems permissible to speak of the medicine of these more remote countries only incidentally, and not as an integral part of the series of centres of learning which made the medicine of ancient Greece the direct ancestor — if I may use such a term — of European medicine.^ In conformity with this idea it will be well to mention here briefly a few of the more important facts relating to the achievements of the physicians of the three countries named.

The most celebrated medical authors in India were Caraka, Siisruta and Vagbhata — *'The ancient trinity," as they were called. Caraka probably lived during the early part of the Christian era, Susruta during the fifth century, and Vagbhata not later than during the seventh century A. D. It is apparent, therefore, that none of the treatises written by these authors could have exerted the slightest influence upon the growth of medical knowledge in ancient Greece.

The crudeness of many of the conceptions held by these Hindu physicians concerning pathology is revealed in the following definition : ' ' Health is the expression of the normal composition of the three elementary substances (air, mucus and bile) which play a vital part in the machinery of the human body, and it is also dependent upon the existence of normal quantitative relations between these three substances; and when the latter are damaged, or when they are abnormally increased or diminished, then disease of one kind or another makes its appearance.'"

2 Neuburger speaks of the growth of medical knowledge in India as a development that ran parallel with that of ancient Greece.

3 From Neuburger. — Equally crude are their ideas respecting the causes of disease, as shown by the following items selected from quite a long list of etiological factors: errors in diet and in the habits of life, climatic influences, psychic factors, heredity, poison, supernatural influences like the anger of the

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Great stress was laid by the physicians as well as by the priests of ancient India upon the observance of very elaborate rules respecting the care of the person while in health and, very naturally, when a patient became ill the physician in charge paid quite as much attention to the employment of hygienic and dietetic measures in effecting the desired cure as to the administering of drugs.

The list of the commonly employed hygienic measures is too long for reproduction in its entirety in this brief sketch, but an enumeration of some of the more important items may prove interesting. In estimating the value of these rules the reader should bear in mind that they were intended for people living in a hot climate. Daily bathing heads the list. Then follow: regulation of the bowels; rubbing the teeth with fresh twigs of certain trees which possess astringent properties, and also brushing them twice a day ; rinsing the mouth with appropriate washes ; rubbing the eyes mth salves; anointing the body with perfumed oils; cutting the nails every five days, etc. Two meals a day were prescribed — the first one between nine in the morning and noon, and the second between seven and ten in the evening. * ' Only a moderate amount of water should be drunk during the meal ; drinking water at the beginning of a meal delays digestion, while a copious draught at the end produces obesity. After the meal the mouth should be carefully cleansed and a short walk should be taken." Among the more important articles of food the following deserve to be mentioned: rice, ripe fruit, the ordinary

gods, the evil powers of demons, etc. For purposes of diagnosis the earlier Indian physicians utilized not only inspection, palpation and auscultation, but also the senses of taste and smell. They noted the losses and increases in the weight of the body, changes in the appearance of the skin, the tongue and the excretions, alterations in the configuration of the body, the form and other characteristics of swellings, etc. They also noted changes in the patient's voice, in the character of the breathing, in the noises accompanying movements of the joints and the twistings of the intestines. The crepitus caused by the rubbing together of the roughened ends of a fractured bone did not escape their notice. At a later period, doubtless through the influence of the teachings of foreign physicians, they attached great importance to the examination of the pulse.

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vegetables, ginger, garlic, salt, milk, oil, melted butter, honey and sugar cane. If meat is eaten, preference should be given to venison, wild fowl and the flesh of the buffalo. The meat of the pig, and beef, as well as fish, are less conducive to health. Gymnastic exercises in moderation are beneficial. Sleep should be indulged in during the day only after some specially severe exercise ; at night it should not be extended beyond one hour before sunrise. Bathing immediately after eating is harmful, and it is not to be indulged in when one is affected with a cold, with a high fever, with diarrhoea, or with some disease of the eyes or ears. A hot bath or washing with warm water may be beneficial for the lower half of the body, but for the upper half it is harmful. Sea bathing and cold baths (preferably in the river Ganges) are beneficial. The clothing worn should be clean ; soiled garments are likely to produce skin diseases. It is advisable to wear shoes, and an umbrella or a staff should be carried. The wearing of garlands, finery, and jewels increases the vital powers and keeps away evil spirits. The following are good measures to adopt for the preservation of health: an emetic once a week; a laxative once a month; and a bloodletting twice a year. All the measures enumerated above were subject to modification according to changes in the season, the locality, the weather, and various other circumstances.

In harmony with the extraordinary fruitfulness of the land the pharmacopoeia of India is very rich. It is a remarkable fact that not one of the nupaerous drugs mentioned in the official list is of European origin. The great majority of them belong to the vegetable kingdom; Caraka stating that he knew of 500 plants that possessed remedial virtues, while Siisruta placed the number at 760. Then, too, the list contains a goodly number of drugs which belong, some to the animal and others to the mineral king- dom. It appears that the physicians of India began using mineral substances, both externally and internally, at a very early period of their history. Among such substances the following may be mentioned: sulphate of copper, sulphate of iron, sulphate of lead, oxide of lead, sulphur.

34 GROWTH OF MEDICINE

arsenic, borax, alum, potash, chloride of ammonium, gold, precious stones of different kinds, etc. The people of India were skilled in chemical and pharmaceutical work. The drugs were prepared by them in a great variety of ways — as, for instance, extracts of the juices of plants, infusions, decoctions, electuaries, mixtures, syrups, pills, pastes, powders, suppositories, collyria, salves, etc. Practicing physicians carried with them a sort of portable medicine chest, and they often collected, themselves, the medicinal plants which they required. Susruta gives instructions as to the spots where certain plants are most likely to be found, and as to the seasons when they should be gathered. Charlatanry and mysticism often played a part in this business. Thus, it was maintained that drugs collected and prepared by persons other than physicians did not produce the desired effects. The fact that cosmetics (especially hair dyes), ''elixirs of life," aphrodisiacs, poisons and antidotes for poisons, occupy the most prominent place in the list of pharmaceutic preparations sold, casts a glaring ray of light, as Neuburger states, on the degree of culture among the people of ancient India.

The list of separate maladies recognized by the physi- cians of the latter country is inordinately long. There were 26 kinds of fevers, 13 species of swellings of the lower abdomen, 20 different diseases due to worms, 20 kinds of urinary diseases, 8 varieties of strangury, 5 kinds of jaundice, 5 varieties of cough or asthma, 18 kinds of ''leprosy," 6 kinds of abscesses, 76 different eye diseases, 28 affections of the ear, 65 disorders of the mouth, 31 nasal affections, 18 diseases of the throat, a large number of mental disorders, etc. It seems scarcely necessary to remark that these so-called diseases were in reality only groups of certain types of loosely related symptoms. The term "leprosy," for example, included, besides the disease which modern physicians call by that name, a number of different affections of the skin. It is worth noting here that diabetes mellitus, which is one of the twenty different kinds of urinary diseases enumerated in the classified list mentioned above, was first described by the physicians of

ORIENTAL MEDICINE 35

India, whose attention was directed to the disorder by observing that flies and other insects were attracted to the urine of these patients by reason of its sweetness. It is also an interesting fact that occasionally these physicians, who, beyond a doubt, were keen observers of symptoms, paid some attention to the anatomical features of the individual cases. Thus, it is stated that the particular form of swelling of the lower abdomen, to which they applied the name ''splenic belly," is dependent upon *'an enlarged spleen which distends the left side, is as hard as a stone, and is arched like the back of a turtle"; whereas they spoke of *'an enlargement of the liver" when very much the same conditions were observed on the right side of the abdomen. The accuracy of their clinical observations is particularly noticeable in their accounts of cases of consumption, apoplexy, epilepsy, hemicrariia, tetanus, rheumatism, venereal diseases, some affections of the skin, and insanity. It was in their surgical technique, however, that the physicians of ancient India were distinguished above all their brethren of the neighboring oriental countries, and this superiority they maintained for a very long time. Among the operations which they performed the following may be mentioned : they removed tumors by excising them, they opened abscesses by the use of the knife, they employed scarifications (in inflanmiations of the throat) and made punctures (in hydrocele and ascites), they passed probes into fistulae, they extracted foreign bodies, and they employed needles armed with hairs taken from the horse's tail or with thread composed of flax or hemp. According to Susruta their stock of instruments was composed of 101 blunt and 20 cutting instruments. Among those which were blunt there were forceps of different sizes and forms, hooks, tubes, probes or sounds, catheters, bougies, etc. They made use of the magnet for drawing out foreign bodies of iron, and they applied cups for therapeutic purposes. Their cutting instruments con- sisted of knives, bistouris, lancets, scissors, trochars, needles, etc. Steel was the metal of which they were made ; for the people of India learned at a very early period how

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to make steel. In suitable cases cauterization, either with the actual cautery or with caustic potash, was a favorite method of treatment with the surgeons of ancient India. "Burning with the heated iron," they taught, ''is more effective than cauterization with potash, inasmuch as it permanently cures diseases which may not be cured by either drugs, surgical instruments, or chemical cauterizing agents." In cases of enlargement of the spleen they plunged red-hot needles into the parenchyma of the organ, presumably through the skin and other overlying tissues. There were fourteen different kinds of surgical dressings ; cotton, woolen, linen and silk being the materials used for bandages, and strips of bamboo or some other wood for splints. When the conditions permitted such a proceeding, it was customary to sew up wounds of the head, face and windpipe. Furthermore, it was the rule to perform all surgical operations at a time when the constellations were favorable. Religious ceremonies were performed both before the operation and after it was completed, and it was also considered necessary that the operator should face the west and the patient the east. Intoxication was employed as a means of securing narcosis. Owing to their scrupulous cleanliness and the minute attention which they paid to details, the surgeons of ancient India obtained for a long time a much higher degree of success than did the surgeons of other oriental nations. At the same time they were not lacking in that degree of boldness which enables an operator — in critical cases which probably without such prompt and radical action would terminate fatally — to save life. For example, they did not hesitate to open the abdominal cavity and to sew up a wound in the intestines ; they cut for stone in the bladder, employing for this purpose the lateral method of operating; and they performed a great variety of plastic operations.

Some of their hygienic rules concerning pregnant and nursing women are eminently practical; others would hardly be approved by modern accoucheurs. Here are a few of these rules: During the period of a woman's pregnancy close attention should be paid to her diet, and

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special care should be exercised by her to avoid excesses or errors of any kind. When the ninth month is reached she should take up her abode in the small cottage in which she is eventually to be confined — a building erected with special religious ceremonies and thoroughly fitted with everything that is likely to conduce to her comfort. At the time of the actual confinement she should have with her four female assistants, and all those measures, of either a religious or a practical character, which have in view the hastening of the birth of the infant, should be scrupulously carried out. If any delay in the delivery of the after-birth occurs, the removal of the mass may be promoted by the employment of well-directed pressure over the lower part of the abdomen, by shaking the body, and also, if necessary, by giving an emetic. The woman in childbed should not be allowed to get up before the tenth day after her confine- ment, and for a period of six weeks her diet should be most carefully watched. On the third day the child should be put to the mother's breast; up to that time it should be given only honey and butter. If the mother, for any reason, is not able to suckle the infant, a wet-nurse should be employed for the purpose, but not until the physician shall have subjected her to a most thorough examination and shall have instructed her minutely in regard to her own diet. The subsequent care of the child was provided for in the most particular manner : It was restricted to a carefully planned diet; it was not allowed to sit or to lie except in certain prescribed positions ; its times for sleep- ing were strictly ordered ; it was permitted to amuse itself only in certain ways; — in brief, everything was done according to strict rules, even special precautions being taken to guard the child, during the first years of life, against dangerous demons. Weaning began after the sixth month, and for a certain length of time the child was fed largely on rice. In cases of difficult labor and in their gynaecological practice the physicians of ancient India did not manifest any special knowledge or skill.

One of the instructions given to young physicians in India when they were about to enter upon the practice of

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their profession, may be of interest to the reader. It is worded as follows: ''Let thy hair and finger nails be cut short, keep thy body clean, put on white garments, wear shoes on thy feet, and carry a staff or umbrella in thy hand. Thy demeanor should be humble, and thy heart pure and free from deceitf ulness. ' ' The following proverb, although it originated in India, is well worthy of acceptance in every part of the world: ''When you are ill the physician will be to you a father; when you have recovered from your illness you will find him a friend; and when your health is fully re-established he will act as your protector."

On a previous page the statement has been made that the science and art of medicine developed in ancient Greece quite independently of any influence that might have been exerted by the teachings of the physicians of India. This statement should be somewhat modified, for it is reasonable to suppose, although directly confirmatory evidence has not yet been discovered, that, through the channels of trade between the two countries, some knowledge of the doings of the physicians of India must have reached the ears of their Greek brethren. On the other hand, at a later period of history (after Alexander the Great had invaded India), the relations between the two countries became quite close and were kept up without a break for several hundred years. During the earlier part of this later period, as appears from the writings of Hippocrates, Dioscorides and Galen, various drugs and methods of treatment employed by the physicians of India were adopted by the practitioners of Greece.

Medicine of the Chinese and Japanese. — The isolation of China with respect to those countries which were within comparatively easy reach and in which there was a civiliza- tion that, already several thousand years before the Christian era, had attained a remarkable degree of development (India, Babylonia and Egypt, for example) ; her blind belief in authority ; her unwillingness to tolerate any influences that seemed to emanate from foreigners; and her complete satisfaction with her own methods of doing things, with her own beliefs, and with her own

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natural and manufactured products, — these, it is generally believed, were the most important factors in keeping this remarkable nation in a state of immobility as regards at least some departments of human knowledge and accom- plishment. This is particularly true in respect of the science and art of medicine. But China is at last waking up from this lethargic state. A wonderful change has come over her during the past twenty or thirty years, and she is now beginning to realize that, with her millions of population and wonderful natural resources, she has an important part to play in advancing the civilization of the world.

The preceding remarks must not be interpreted as signifying that, during the long ages of the past, China has not been developing and is not able at the present time to show a record of very creditable work accomplished in many departments of human activity. In her early history, many centuries ago, she accomplished great things, and all — so far as we now know — ^without aid from neighboring nations; but there came a time when all this creative activity ceased, and then, for long periods of years, she appeared to rest satisfied with the advances which she had already made, and to have no further ambition to add to the stock of her possessions.

Among the valuable things which should be credited to the Chinese are the following: the discovery of the compass (about 1100 B. C), the making of porcelain, the invention of printing, the raising of silkworms, the manufacture of glass and of paper, the successful dyeing with purple, embroidering with gold, working in metals, the artistic cutting of precious stones, enameling, the making of * ' India ink," etc. Furthermore, it is a fact most creditable to the Chinese that in no other country in the world have scholars been held in such high esteem, or assigned so high a rank, as they have been and still are in China.

Chinese medicine possesses a very rich literature. The first medical treatise, which deals with plants that possess medicinal virtues, is ascribed to the Emperor Schin-Nung, who flourished about 2800 B. C. This is the monarch who

40 GROWTH OF MEDICINE

taught his people from which springs they should drink, and who tested all the plants of his vast empire with reference to their healing properties. According to the legend the wall of his stomach was so thin that he could look through it and see everything that was going on in the interior of that organ. In this way he was able to carry on a large series of experiments upon himself in regard to the action of different poisons and their antidotes. It is also related that medical knowledge was still further advanced by the yellow Emperor Hoang-Ti who lived about 2650 B. C, and who is credited by the Chinese with having invented arithmetic and music. The treatise called ''Noi- King," which deals with the subject of internal diseases and gives a systematic account of human anatomy, is also credited by the Chinese to this monarch; but Neuburger maintains that this book, which is still in common use in China, is of much more recent origin. There are several other medical treatises which deserve to be mentioned. Such, for example, are the following: the celebrated book on the pulse, written by Wang-Schu-Scho in the third century B. C. ; two very important books written by Cho- Chiyu-Kei — one bearing the title ''Schang-Han-Lun" (On Fevers) and the other that of ''Kin-Kwei" (Golden Casket) ; — the different treatises written by Tschang-Ki (tenth century A. D.) and published in the collection called **The Golden Mirror of the Forefathers in Medicine" (I- Tsung-Kin-Kien") ; and, finally, the very popular modern work (in forty volumes) entitled ^'The Trustworthy Guide in the Science and Art of Medicine" ('*Ching-Che-Chun- Ching"). Of these forty volumes, seven are devoted to nosology, eight to pharmacy, five to pathology, six to surgery, and the remainder to children's and women's diseases.

Anatomy, it appears, has never played other than a very insignificant part in the Chinese system of medicine. This is not to be wondered at when we remember that their religion makes the dissection of a human body a sin worthy of punishment. No mutilated person, the Chinese believed, would be permitted, upon reaching the domain of the dead,

ORIENTAL MEDICINE 41

to rejoin Ms ancestors. About the year 1700 A. D. the Emperor Kang-Hi made the attempt to incorporate anatomy as a part of the regular study of medicine in the Chinese Empire ; his first step being the authorization of P. Perennin, a Jesuit Father, to translate Dionis' work on anatomy into the Chinese. His efforts were, however, unsuccessful, owing to the strong opposition offered by the native physicians. And the attempts made during more recent times to accomplish the desired reform by intro- ducing copies of European anatomical illustrations do not appear, as yet, to have produced any appreciable impres- sion. In very recent years, however, the medical mission- aries, sent out, if I am rightly informed, from the United States, are giving excellent instruction in anatomy.

Physiology, as taught by the Chinese, is something beyond the comprehension of modern Europeans. Neu- burger explains their views in the following manner: ''The cosmos is the product of the combined action of two dissimilar forces — the male (Yang) and the female (Yin). When these forces work in harmony a state of equilibrium

results Matter consists of five elements, viz.,

wood, fire, earth, metal, and water; and all things are composed of these elements. In sympathetic relationship with these five elements stand the five planets (Jupiter, Mars, Saturn, Venus, Mercury), the five different kinds of air (wind, heat, moisture, dryness, cold), the five quarters of the globe (east, south, west, north and the equator), the five periods of the year (in addition to the four which we recognize, the Chinese make a fifth period out of the last eighteen days of spring, summer, autumn and winter), the five times of day, the five colors (green or blue, red,

yellow, white and black), the five musical tones, etc

As in the cosmos, so in man the two primeval forces — Yang and Yin — underlie all his vital processes. Thus, his body is made up of the five elements of which all matter is composed, and health depends upon the maintenance of a state of equilibrium between the male and the female forces, etc." After this brief exposition it seems unneces-

42 GROWTH OF MEDICINE

sary to devote any further space to the consideration of the physiological doctrines of the Chinese.

With respect to the questions of diagnosis and prognosis it may be stated that the Chinese attach great importance to the necessity of making a most careful objective exami- nation of the entire body; but, when one investigates the precise manner in which this examination is to be carried out, it soon appears that most of the details relate to matters of a purely fanciful or mystical nature. The only steps of real importance, according to them, are the exami- nation of the patient's pulse and the inspection of his eyesight and his tongue. From the examination of the pulse alone they believe it possible to diagnose the nature and seat of the disease. To examine the pulse properly is a complicated affair and can scarcely be carried out in actual practice in less time than ten minutes; indeed, in certain cases the physician may find it necessary to devote two or three hours to the business. According to the Chinese scheme there are many different kinds of pulse, and there are no less than thirty-seven different types of condition presented by the tongue, each bearing its own special pathological significance.

Disease, so reads the Chinese doctrine, is a discord, a disturbance of equilibrium, caused by the preponderance of one or the other of the primeval forces (the male or the female). It manifests itself in some disorder of the circulation of the vital air and the blood, and eventually involves the organs of the body. Wind, cold, dryness, moisture, the emotions and passions, poisons, and also evil spirits and imaginary beasts are the causes of disease.

No other nation, says Neuburger, has at its command such a large number of remedial drugs; and it is also a fact, he adds, that the department of therapeutics is that in which Chinese medicine has reached its highest develop- ment. The steadfast belief that in nature there exists a remedy for every human ill led the physicians of that country to search diligently in all possible directions for vegetable and animal and also, to some extent, mineral substances which might possess remedial virtues. Although

ORIENTAL MEDICINE 43

this search necessarily brought to notice a lot of useless drugs, it cannot be denied that eventually it added a considerable number of remedies which have proved useful to the medical profession of the entire world. In this category belong the following: rhubarb, pomegranate root as a cure for worms, camphor, aconite, cannabis, iron (for the relief of anaemia), arsenic (for malarial and skin diseases), sulphur and mercury (both of these for affections of the skin), sodium sulphate, copper sulphate (as an emetic), alum, sal ammoniac and musk (for nervous affections). Toward the middle of the sixteenth century A. D. there was published, under the title ''Pen-Tsao- Kang-Mu," a monumental work (fifty-two volumes) in which are very fully described no fewer than 1800 remedies, mostly of a vegetable nature. Prophylactic Inoculation with the pus from a smallpox pustule was practised by the Chinese as long ago as during the eleventh century A. D., ''thus constituting a forerunner of our modern serum therapy." (Neuburger.) Vaccination was not introduced into China until during the nineteenth century of the present era. It is a curious fact that, in the choice of a remedy, the Chinese physicians attach a certain degree of importance to the form and color of the drug, as symbols indicative of the effect which they may be expected to produce. Thus, the red blossoms of the hibiscus plant are believed to be more efiicacious than the white as an emmenagogue; saffron, being of a yellow color, possesses the power to relieve jaundice; beans that have the shape of a kidney should be prescribed in cases of renal disease ; glow-worms should form a part of all eye-washes, etc.

The doses prescribed are very large, and the medicines are often put up in an attractive form, with labels on which such descriptive titles as these are written: ''Powders of the Three very wise Men," or "Powders recommended by Five Distinguished Physicians" — titles which are calcu- lated to work upon the imagination of the patient.

There are two methods of treatment which the Chinese physicians are very fond of employing for the relief of a great variety of diseases — viz., acupuncture and cauteriza-

44 GROWTH OF MEDICINE

tion of the skin over the seat of the malady by means of what are termed *'moxae" — moxibustion. Moxae are pre- pared by kneading together into a cone-shaped, tinder-like mass the leaves of the artemisia vulgaris, then drying it thoroughly. Such a mass is attached to the skin at the affected spot by simply moistening the base of the cone, after which the apex is ignited. Some physicians prefer to interpose a thin sheet of metal between the skin and the base of the moxa. The manner in which these contrivances should be used in the different diseases and the proper number to employ are matters subject to fixed rules. In a strong individual, for example, as many as fifty moxae may be used at a time. In affections of the chest they were applied to the patient's back, in diseases of the stomach to the shoulders, and in venereal affections over the spinal column. In acupuncture, which is a procedure invented by the Chinese, slender needles of gold, silver or highly tempered steel, from 5 to 22 centimetres (2 in.-8% in.) in length, were forced through the stretched skin to different depths (1% in.-134 in.) and then driven farther inward in a rotary direction by means of a small hammer. The needles, after being allowed to remain in situ for a few minutes, were withdrawn, and pressure was made with the hand over the small wounds, or a moxa was burned over the spot. There are in all 388 places where acu- puncture may be performed, and a chart of the body, showing where these places are located, has been prepared for the guidance of the Chinese physicians. Neuburger calls attention to the fact that the latter dislike the sight of blood, and that this is one of the reasons why acupunc- ture and the use of moxae have grown to be such popular remedies. Bloodletting is rarely employed by them; but dry cupping, on the contrary, is a favorite procedure in certain maladies. Massage is generally performed by old or blind women, and much attention is devoted to the ''movement cure," which is said to have been invented about 2500 B. C.

As may readily be imagined, the Chinese — owing to their dislike for the sight of blood and also by reason of

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their ignorance of anatomy — ^have not advanced, in sur- gery, beyond the most primitive state of that art.

The science of public health is quite unknown in China. In a Chinese treatise entitled ''Long Life," the following advice is given: ''Always rise early in the morning, take some breakfast before you leave your residence, drink a little tea before eating, at the mid-day meal partake of well-cooked but not too highly salted food, eat slowly, take a nap of two hours after the meal, eat lightly at night, and, before going to bed, rinse your mouth with tea and have the soles of your feet rubbed until they are warm." (Neuburger.)

Up to the latter part of the nineteenth century of the present era, Japan, so far as medical matters are con- cerned, differed in no material respect from China. During the last fifty or sixty years, however, — that is, since the visit of Commodore Perry, of the United States Navy, to that country, — wonderful changes have taken place; and now Japan, as a result of her determination to adopt the methods of education, of utilizing steam and electric power, etc., has already taken a leading place in the council of nations. The physicians, many of whom received their training in the best schools of Europe and the United States, are contributing to-day their full share toward advancing the science of medicine. That China is fol- lowing in the footsteps of Japan is already plainly evident, and no intelligent observer entertains the slightest doubt of her ultimately — probably at no distant day — possessing a corps of medical men as well educated, as efficient in the treatment of disease, and as practical in public hygiene as their European and American confreres. During thou- sands of years China has suffered severely from the blighting tyranny of superstition, priestcraft and selfish bureaucracy, and, now that the sunlight of truth and genuine liberty is beginning to search every nook and cranny of that great country, we who have had the advan- tage of this beneficent influence for so many scores of years truly rejoice over the change that is taking place in China.

CHAPTER IV

GREEK MEDICINE AT THE DAWN OF HISTORY

It is from Greece and from Greece alone, says Darem- berg, that our modern medicine derives its origin.

It has come down to us, in a direct line, through the sheer force of its inherent excellence, and with little or no aid from outside sources. Harvey, Bichat and Broussais are as much the legitimate heirs of Hippocrates, Herophilus, Galen, Berenger de Carpi and Vesalius, as Hippocrates is the heir of Homer, and as this divine singer of the anger of Achilles is himself the product of a civiliza- tion that existed before his day and that was in all probability the creation of Hindu influences.

It is to the development of medical knowledge in Greece, therefore, that our attention should next be directed, and more particularly to that period which belongs to the dawn of history — the pre-Homeric period.

The pre-Homeric Period of Medicine in Greece. — The poems of Homer, the Iliad and the Odyssey, furnish us with the earliest and almost the only written evidence of the state of medicine in Greece during that period of time. They were probably written, according to the authority of the Earl of Derby, somewhere about 800 B. C, and modern investigations show that the siege of Troy, the theme of the Iliad, occurred between the years 1194 and 1184 B. C. These investigations also show that in this region, and especially in the Island of Crete and in Mycenae on the neighboring mainland of Asia Minor, at this time and probably several hundred years earlier, there existed a high degree of civilization. Specimens of a written language, for example, were found among the objects recovered from the ruins of the palace of King Minos at

GREEK MEDICINE 47

Cnossus in Crete, but hitherto no interpreter of this unknown language has been found. It is reasonable to expect, however, that in due time these Minoan records will be translated, that still other records belonging to this remote age will be discovered, and that much valuable information regarding the condition of medical knowledge in Greece during this long period will then be revealed to us. Strange as it may appear, the classical Greek writers seem to have possessed very little knowledge concerning this highly developed civilization at Cnossus. And yet, if we stop to consider the matter, their silence will appear less strange for the following reasons. Some great calamity (war, an earthquake, or a conflagration) must have destroyed many of the evidences of Minoan civiliza- tion besides those which are now being brought to light; then, also, several hundred years elapsed between the occurrence of this disaster and the classical period of Greek culture ; and, finally, there is the fact that the knowl- edge of past historical events, when kept alive simply by tradition, slowly vanishes, until finally it becomes so vague as to possess very little value. The discoveries made in the Island of Crete and at Mycenae were not known to Daremberg when he wrote the lines quoted above, but he felt perfectly sure, from his knowledge of the laws of development in general, that a product so highly cultured as Homer could not have suddenly sprung into existence out of the apparent darkness and ignorance of the centuries immediately preceding his time.

The State of Medical Knowledge at the Time of the Siege of Troy. — It is from Homer's Iliad and Odyssey that our authoritative knowledge of the most ancient Greek medicine is derived. In the former work mention is made of Aesculapius and his two sons, Machaon and Podalirius, both of whom accompanied Agamemnon and the Greek host in their expedition against Troy. According to this author's account they served in the double capacity of surgeons to the army and valiant leaders of troops. In order that the reader may judge for himself just what is the nature of the evidence furnished by Homer with regard

48 GROWTH OF MEDICINE

to the medical knowledge of that period, it seems desirable to introduce here a few of the more characteristic refer- ences which the poet makes to spear, javelin and arrow wounds, to the injuries caused by fragments of rocks hurled by the assailants, and to various remedial measures, both surgical and medical, employed for the relief of the wounded or sick warriors. There are at least one hundred such passages in the Iliad alone, but the few which are here cited will serve as adequate examples of Homer's famil- iarity with anatomy and with some of the methods of treating spear and arrow wounds, — a familiarity which indicates that the poet must have had some medical training.

Thus he ; and not unmoved Machaon heard :

They through the crowd, and through the wide-spread host,

Together took their way ; but when they came

Where fair-hair 'd Menelaiis, wounded, stood,

Around him in a ring the best of Greece,

And in the midst the godlike chief himself,

From the close-fitting belt the shaft he drew,

With sharp return of pain ; the sparkling belt

He loosen 'd, and the doublet underneath,

And coat of mail, the work of Arm 'rer 's hand.

But when the wound appeared in sight, where struck

The stinging arrow, from the clotted blood

He cleans 'd it, and applied with skilful hand

The healing ointments, which, in friendly guise.

The learned Chiron to his father gave.

(Book lY. of the Iliad, Lines 221-259.)

He said : the spear, by Pallas guided, struck

Beside the nostril, underneath the eye ;

Crashed through the teeth, and cutting through the tongue

Beneath the angle of the jaw came forth :

Down from the car he fell ; and loudly rang

His glittering arms : aside the startled steeds

Sprang devious : from his limbs the spirit fled.

Down leaped Aeneas, spear and shield in hand.

Against the Greeks to guard the valiant dead;

And like a lion, fearless in his strength,

GREEK MEDICINE 49

Around the corpse he stalk 'd, this way and that,

His spear and buckler round before him held,

To all who dar 'd approach him threatening death,

"With fearful shouts ; a rocky fragment then

Tydides lifted up, a mighty mass,

"Which scarce two men could raise, as men are now :

But he, unaided, lifted it with ease.

With this he smote Aeneas near the groin,

"Where the thigh bone, inserted in the hip.

Turns in the socket joint ; the rugged mass

The socket crushed, and both the tendons broke.

And tore away the flesh : down on his knees,

Yet resting on his hand, the hero fell ;

And o'er his eyes the shades of darkness spread.

(The Iliad, Book V., Lines 333-356.)

He said, and passing his supporting hand

Beneath his [Eurypylus'] breast, the wounded warrior led

"Within the tent ; th ' attendant saw, and spread

The ox-hide couch ; then as he lay reclined,

Patroclus, with his dagger, from the thigh

Cut out the biting shaft ; and from the wound

"With tepid water cleans 'd the clotted blood ;

Then, pounded in his hands, a root applied

Astringent, anodyne, which all his pain

Allayed; the wound was dried, and stanch 'd the blood.

(The Iliad, Book XI., Lines 958-967.) • #****«#«

But Jove-born Helen otherwise, meantime.

Employed, into the wine of which they drank

A drug infused, antidote to the pains

Of grief and anger, a most potent charm

For ills of every name.^ "Whoe 'er his wine

So medicated drinks, he shall not pour

All day the tears down his wan cheeks, although

His father and his mother both were dead,

Nor even though his brother or his son

Had fallen in battle, and before his eyes.

(Book IV. of the Odyssey, Lines 275-284.) 1 Nepenthes, believed to be opium, is the word employed in the original.

50 GROWTH OF MEDICINE

In former years and down almost to the present time, it was the custom among English medical writers to speak of Aesculapius only as the ''God of Medicine," thus con- veying to the minds of many readers that he was a mythological character, not a real personage. To-day, and especially since Schliemann has demonstrated, by his excavations at the site of ancient Troy, that Homer's Iliad is not merely a beautiful creation of his poetic fancy, but a narration of events that actually occurred about 1200 B. C, it is quite generally acknowledged that Aesculapius^ is an historical character, an individual whose memory should receive due honor from the physicians of modern times. Neither Homer nor Pindar speaks of him as a god. In Athens he was publicly deified in 420 B. C.

When Daremberg, as quoted above, expressed the belief that Hippocrates was the product of an earlier civilization, he undoubtedly gave due weight to other circumstances beside those which are narrated in Homer's poems — circumstances, for example, which are referred to casually by several of the classical Greek authors, and to which fresh importance has been given by a number of recent discoveries. Thus, there is an abundance of evidence showing that the Greeks, both before and after Homer's time, held the memory of Aesculapius in the very highest honor. So great, as they believed, was his power over disease, so wonderful were the cures which he accomplished, and so noble and pure was his character, that they made him a god and erected temples in his honor — not mere places where a barren worship might be carried on, but veritable sanatoria — termed Asclepieia — where the extraor- dinary healing powers of him whom they had made a god might be perpetuated for the benefit of succeeding

2 Aesculapius was held to be the son of Apollo, the god of medicine, and to have been instructed in the art of healing by Chiron, one of the centaurs. Beside his famous sons, Machaon and Podalirius, he had four daughters whose names — Hjgieia, Jaso, Panakeia and Aigle — have come down to us through the ages. His wife's name was Epione, and those of his two younger sons were Telesphorus and Janiscus, but all three of these names are rarely men- tioned by the Greek writers.

GREEK MEDICINE 51

generations. While, on the one hand, the ancient Greeks may have been full of superstitious beliefs, they were at the same time as kindly disposed toward their fellow men, as generous in their spending of money for this purpose, and as practical in their selection of suitable methods as are the benefactors of to-day all over the world. In course of time these so-called temples became the prototypes of our hospitals, sanatoria and schools of medicine, and it therefore seems only proper that they should here be described somewhat in detail.

The so-called Aesculapian Temples and their Chief Purpose. — The first of these temples, or Asclepieia, were established at Trikka, in Thessaly ; at Cnidus, on the coast of Caria in Asia Minor, opposite Cos; at Epidaurus, in Argolis, Greece ; at Gyrene on the northern coast of Lybia, Africa, opposite the Island of Crete; at Crotona, on the southeastern coast of Italy; and, finally, at Athens. It is said that traces of as many as eighty of these Asclepieia have been found in different parts of the ancient world. One of them, for example, is known to have existed on the small island (Isola San Bartolommeo) in the Tiber, at Rome. Their management was intrusted, in the earlier years of their existence, to men who were descendants of Aesculapius — i.e., the sons and grandsons of Machaon and Podalirius. They were both priests and physicians, and are mentioned in history as the Asclepiadae. With the progress of time it became necessary, as one may readily understand, to intrust the temple service to individuals who were not members of the family of Aesculapius. The original Asclepiadae guarded as valuable secrets the methods of treatment and the pharmaceutic formulae which had been handed down to them by the head of the family. It was therefore natural, when these newly adopted members were installed in office, that they should be made to promise, under oath, not to *' divulge these secrets to any but their own sons, the sons of their teachers, or the pupils who were preparing themselves to become regular physicians." (Neuburger.)

The divulging of these secrets, it may be assumed,

52 GROWTH OF MEDICINE

would gradually entail upon the organization of priest- physicians a serious money loss. As will be seen further on, the oath known as *'the Hippocratic Oath" omits these mercenary features, and thus places the vocation of physician upon a much higher level.

It is an interesting fact, as noted by Hollaender, of Berlin, that Homer does not make the slightest mention of temples dedicated to Aesculapius; from which circum- stance it may be inferred that a long time — perhaps several hundred years — elapsed, after his death, before his country- men realized fully his greatness and the value of the services which he had rendered in his role of physician. Of the temples which were then built in his honor, all have long since fallen into ruins, but in recent years excavations have been made at some of the more important of these sites and under the guidance of competent scholars, and as a result our knowledge of the state of medicine in Greece between the time of Homer and the appearance of the Hippocratic writings has been greatly enlarged. The facts revealed by these excavations and the staternents which are to be found in classical Greek literature, but which previously did not receive all the consideration that they deserved, have now been pieced together and we have thus been furnished with a fairly satisfactory picture of the relations of the different chambers and spaces in these temples, and with a more or less complete account of the manner in which affairs were conducted by those in charge. The following short description which is based on the account recently published by Professor Meyer-Steineg of Jena, Germany, will put the reader in possession of all the more important facts.*

There were two principal types of Asclepieia — one, like that of Epidaurus, in Argolis, which occupied an inland situation, that had clearly been chosen from religious motives alone, viz., because it was believed, in accordance with an ancient tradition, that at this spot Aesculapius had

3 ' ' Kranken-Anstalten im grieehisch-romischen Altertum, ' ' von Dr. med. et jur. Theodor Meyer-Steineg, a. o. Professor an der Universitat Jena; Verlag von G. Fischer, 1912.

FIG. 1.

VIEW OF THE TEMPLE OF AESCULAPIUS ON THE ISLAND OF COS.

As it must have appeared to the traveler, in the third century B. C, on his approach by sea to the port of that island.

Reconstitution based upon recent photographs and upon surveys by Herzog {Koische Forschungen, 1904).

(Courtesy of^Prof. Dr. Meyer-Steineg, of Jena, Gennany.)

GREEK MEDICINE 53

been born — and a second, like that of Cos, on the island of the same name in the Aegean Sea, which situation without doubt had been chosen chiefly because the locality was exceptionally healthful. Of the first of these two types of temples, the sites of both of which have been most carefully studied, very little need be said in this brief sketch. The purely medical aspects of this Asclepieion, to which at the height of its celebrity crowds flocked from all parts of Greece, are of minor interest. The temple and its accessory buildings, which appear to have been very extensive, were located in a narrow valley, not far distant from the seaside village which still to-day bears the name of Epidaurus. Then, also, the locality is deficient in one important respect — it has an insufficient supply of good drinking water; and, finally, it is only slightly elevated above the sea-level. Dr. Meyer-Steineg remarks that the patients who visited this temple must have owed whatever benefit they derived from the visit to other influences than those of a purely medical or hygienic character. Doubtless suggestion played an important part in any relief which they may have obtained, and the so-called temple-sleep was also doubtless a very effective factor in this direction. The Asclepieion at Cos, on the other hand, occupied a most healthful position on the northern slope of the ridge of mountains which extends throughout the entire length of the island and attains a maximum height of about 3000 feet. (See Fig. 1.)

It now remains for me to describe, as best I may within the limited space which is at my command, the results of the excavations and surveys that have been made in recent years on the Island of Cos. Professor Meyer-Steineg 's article on this subject* is the source from which I have derived the information contained in the following account.

The temple and its associated buildings stood at an elevation of three hundred feet above the sea-level and at a distance of a little more than two miles from the city of Cos. The heights behind the temple were in former

* ' ' Kranken-Anstalten im griechisch-romischen Altertum, * ' in Jenaer medisin.-historische Beitrdge, Jena, 1912.

54 GROWTH OF MEDICINE

times covered with forests and afforded ample protection against the debilitating and much-dreaded south wind. A brook of considerable size and of very pure water passed through the temple grounds; the spring (Burinna) from which it took its origin being located about 300 feet higher up on the side of the mountain. Not far off, in the same neighborhood, is a mineral spring, the water from which contains both iron and sulphur. All the physical conditions of this site were, therefore, very favorable to the restora- tion of both mental and bodily health. Professor Meyer- Steineg declares that it is scarcely possible to determine accurately the age of the Cos Asclepieion, — i.e., of the structures which the present ruins represent, — but he believes that some of them date no farther back than the third century B. C, at which time extensive structural alterations were made.® Then, at a still later date (first century A. D.), in consequence of the damage done by an earthquake, C. Stertinius Xenophon (at the instigation of the Roman Emperor Claudius, whose private physician he was) carried out some very radical changes. Not only were the separate buildings well supplied with running water, but even many of the individual rooms (of which there were a large number) were equipped mth the same conveniences. Hydropathy evidently formed an important part of the treatment in the reconstructed temple. (See Fig. 2.)

As has been shown above, the climate, the freedom from disturbing factors of all kinds, the existence at that spot of a plentiful supply of pure water, the character of the structures composing the temple group, and the wide- spread belief among the people that the Asclepiadae were able, with the assistance of the god Aesculapius, to effect cures which were obtainable nowhere else — all contributed to make the temple at Cos one of the greatest sanatoria of ancient times.

The buildings which constituted what is commonly termed the ''Temple of Aesculapius" at Cos were located on three artificially prepared terraces. The principal

6 All important traces of the earlier structures seem to have disappeared.

rv

FIG. 2. BIRD'S-EYE VIEW OF THE TEMPLE OF AESCU- LAPIUS AND ASSOCIATED BUILDINGS ON THE ISLAND OF COS.

As they appeared in the third century B. C.

(Copied by permission from a model made by Prof. Dr. Meyer- Steineg for the Medico-historical Museum of the University of Jena, Germany.)

GREEK MEDICINE

55

entrance to the group, as the excavations conducted quite recently by Herzog show, was on the lower terrace, and faced north — that is, toward the sea. From this lower level a broad staircase led to the second or intermediate terrace, which, in turn, was connected with the upper one by means of a very broad and massive series of steps. The southern limit of this upper terrace ended abruptly at the slope of the mountain. The arrangement of the buildings

M

jllllii'ii' ^

^,m,«iiiiim«\imwt«i«iii«»

Ha fs St at)

W i 8 B 38 •« ia ic ^ ' ti 1i toon

PIG. 3. GROUND PLAN OP THE ASCLEPIEION ON THE ISLAND OP COS. As Ascertained by the Researches of Dr. Herzogr.

The different structures are arrangred as nearly as possible in the same positions which they occupied in the third century, B. C.

A, main entrance to Asclepieion; B, B, B, gallery, 6 metres broad, with colonnade on one side; C. open space or court, on the southern side of which is a structure composed of recesses provided each with a bathing basin (/?)/ H, staircase leading to intermediate terrace; a, massive series of steps leading to the upper terrace; *, b, b, broad gallery similar to that shown on the lower terrace; rf, the temple proper.

(From Prof. Dr. Meyer-Steineg's Medizinisch-historiiche Beitrage.)

56 GROWTH OF MEDICINE

on the three different terraces may, in harmony with the account given by Professor Meyer-Steineg, be briefly described as follows: That which stood on the lower terrace occupied three sides of a parallelogram (Fig. 3), the open part of which faced south. The longer side of the building measured about 120 metres (390 feet) in length, and the two shorter sides each 55 metres (180 feet). The supply of running water in every part of this great building, which appears to have been devoted mainly, if not entirely, to therapeutic purposes, must have been most abundant. The source from which the water came was the Burinna spring, situated higher up on the mountain at a spot far beyond all possibility of contamination. It is not yet clear, says Dr. Meyer-Steineg, whether or not there were any buildings devoted to therapeutic purposes on the intermediate terrace. (Figs. 2 and 3.) On the other hand, the great halls, contained in the large building which surrounded the temple on the upper terrace, appear to correspond very closely to the rooms that constituted the main portion of the building on the lower terrace, and it is therefore probable that this upper building also served some useful purpose in the general scheme of the Ascle- pieion. It is Herzog's opinion — according to Meyer- Steineg — that the central idea around which everything in this assemblage of fine buildings revolved, was a clinic conducted by the Asclepiadae. The means chiefly employed at first for the restoration of health were such simple agents as sunlight, pure air, pure drinking water, dietetic measures, massage, physical exercise, etc., and yet, when the patient's condition seemed to require their use, there was no hesitation in resorting to the rational employment of drugs, and even surgical operations were performed. The numerous instruments which Dr. Meyer-Steineg col- lected at the site of the ruins when he visited Cos in 1910, furnish ample corroborative evidence of the correctness of this last statement.

Not the least important part which this famous Ascle- pieion played in the history of medicine was the splendid opportunity which it afforded to those who were preparing

GREEK MEDICINE 57

themselves to engage in the practice of the healing art, for acquiring the necessary familiarity with the different diseases and for learning how they should be treated.

The manner of conducting the preliminary treatment was probably not the same in every particular in all the different Asclepieia, and yet in the main the plan of procedure followed in Epidaurus, in Cos and in Athens undoubtedly resembled closely that which Pagel furnishes in his Geschichte der Medizin. It may be briefly described as follows : —

In the first place, moribund persons, the unclean, and women about to be confined were not admitted into the temple enclosure. The management of the latter class of patients was left entirely to women nurses, and, when it became evident that a person was likely to die, the indi- vidual was thereafter cared for outside the enclosure.® In short, everything possible was done to keep out of sight all such objects as might produce an unpleasant impression upon applicants for treatment. After preliminary bathing and dieting, the patient was conducted into the temple enclosure and encouraged to make offerings and to pray to the god Aesculapius, an imposing statue of whom in marble was one of the first things that confronted him. As he was led about by the priest or an attendant, his imagination was wrought upon by the sight of numerous votive offerings exposed to view on the walls or columns of the buildings, by the singing of hymns in adoration of the god, and by the reading of the records of earlier cases inscribed on tablets or on the columns. After his mind had thus been worked upon, he was asked to furnish to the priest a detailed history of his own case and to submit to some sort of physical examination. As a final and most important step in this first stage of the treatment he was subjected to what was termed ''the temple-sleep," during which the suggestion of the proper remedies to be employed was supposed to be communicated to him by the god himself.

« The Emperor Antoninus Pius, in order to provide properly for these patients, erected at Epidaurus a special building in which confinement cases and those likely to end fatally might be lodged.

58 GROWTH OF MEDICINE

In our day it is difficult to understand how persons of a fair degree of intelligence could for so long a period have continued to believe in the efficacious interference of the deified Aesculapius in their behalf. But that this belief really did exist is well known, and it was only after the lapse of many centuries that the faith of the public began to weaken, doubtless through the influence of several factors. Perhaps the most important of these was the discovery of an increasing number of instances of hum- buggery or trickery, of which the officiating priests, in some of the temples, had been guilty. The satirical writer, Aristophanes, who flourished in Athens about 400 B. C, describes an incident of this nature in his play entitled *'Ploutos." The following extracts furnish an account of the doings observed by the slave Karion on the occasion of his passing a night in the temple enclosure at Athens : —

The Scene throughout is laid at Athens, in front of the house of Chremulos.

Blepsidemos : Ought n't we then to bring in some doctor?

Chremulos: Prythee, what doctor is there now in the city? For their pay is no longer anything worth, nor their art.

Blep. : Let us cast about.

Chrem.: Nay, there is not one.

Blep. : I believe there is not.

Chrem.: Nay, by Zeus, the best plan is to do what I have been long preparing — (to conduct him [Ploutos] ) to the temple of Asklepios [and] make him lie down [there].

Chrem.: Karion, my man, you must bring out the bed-clothes and lead Ploutos himself in the usual way, and carry everything else that is ready within.

{Exeunt omnes.)

Chorus of Farthers. What is the matter. Oh thou best friend of — thyself? For you seem to have come as a messenger of some good news.

GREEK MEDICINE 59

Karion!' My master has fared most prosperously, or rather Ploutos himself. For, instead of being a blind man, he has been made to see again, and his pupils are clear-sighted, as he has met with a kindly friend in Asklepios the Healer.

Chorus. You give me reason for joy, reason for shouts of triumph.

Karion. Ye have reason to rejoice whether ye wish it or not.

Chorus. I will shout aloud for Asklepios of the goodly children, the great light to mortals.

• *••••••••

Karion. Well, as soon as ever we came to the god, leading a man then, indeed, most miserable, but now blessed and fortunate, if any other is so, first we led him to the sea, and then we bathed him.

Wife of Chremulos. By Zeus, then the old man was fortunate, bathing in the cold sea.

Karion. Then we went to the sacred enclosure of the god. And when on the altar the cakes and offerings were dedicated by the flame of murky Hephaistos, we laid down Ploutos, as was proper; and each of us made up from little odds and ends a bed for himself.

Wife. Then were there certain others beside yourselves wanting the god ?

Karion. Yes, Neokleides, for one, and he is blind; but in stealing has far overshot those who can see ; and there were many others with all sorts of ailments. But when the minister of the deity put out the lights and told us to go to sleep and said that we were to keep silent, if any of us perceived a noise, we all lay down in an orderly manner. And I was unable to sleep, for my attention was arrested by a certain pitcher of porridge a little way off from the head of a certain old woman, and, I strangely desired to creep over to that pitcher. Then I looked up and saw the priest making a clean sweep of the cakes and dried figs from the sacred table. After this he went round all the altars in a circle to see if any cakes were left anywhere. Then he consecrated them into a certain wallet; and I, believing that there was great holiness in this proceeding, rise up to go to the pitcher of porridge.

Wife. Oh you most miserable of men, were you not afraid of the god?

Karion. Yes; by the gods I was afraid lest he with his fillets should reach the pitcher before me; for the priest had already

' The slave of Chremulos.

60 GROWTH OF MEDICINE

given me a lesson. But, as soon as ever the old woman perceived the noise I made, she lifted up her hand over the pitcher (to protect it). Then I hissed and seized (her hand) by the teeth as if I were a reddish-brown snake. But she at once drew back her hand again and lay down peacefully, rolling herself up. And then I at once gulped down a lot of the porridge; and then, when I was fuU, I jumped up again.

Wife. And didn't the god come up to you?

Karion. Not up to that time. After this I at once covered myself up, being afraid ; but he made a complete circuit examining all the ailments in a most orderly fashion ; and then a slave set by him a little mortar and box of stone.

Wife. Of stone ?

Karion. No, by Zeus, certainly not, — at least, not the box.

Wife. To the deuce with you, how did you see since you say you were covered up ?

Karion. Through my old cloak; for, by Zeus, it had holes not a few. First of all, he took in hand to pound a plaster for Neo- kleides, and he threw in three cloves of Tenian garlic. Then he bruised them in the mortar, mixing therewith the acid juice of the fig-tree and squill ; then, having diluted it with Sphettian vinegar, he turned his eyelids inside out that he might feel more pain, and then applied the mixture. But he, squalling and bawling, jumped up and was running away, when the god said with a laugh : — * ' Sit down there now, smeared with thy plaster, that I may stop thee from going to the Assembly, having for once a real excuse. ' '

Wife. What a patriot and sage the god is !

Karion. After that he sat down by the side of Ploutos, and first he touched his head, and then, taking a clean towel, he wiped his eyelids all round, and Panakeia covered his head and all his face with a cloth of purple dye ; and the god then whistled. Thereupon two snakes of monstrous size darted forth from the temple.

Wife. Dear Gods !

Karion. And these two (snakes) having quietly glided under the crimson cloth, licked his eyelids all around, methought. And before you could drink ten cups of wine, my mistress, Ploutos stood up and was able to see : and I clapped my hands with delight and awoke my master. And the god suddenly took himself off from our view with the snakes into the temple.

If one examines carefully the facts connected with the Aesculapian temple treatment, so far as they are known

GREEK MEDICINE 61

to us, one cannot fail to be impressed with their strong resemblance to what has been the experience of similar semi-religious movements in more recent times, not only in European countries but also in the United States. In all of them there may be found a kernel of true religious belief, and no candid observer can deny the fact that many persons have been benefited thereby both in body and in mind. But, sooner or later, the method has fallen into disrepute, either because it was employed in the vain hope that it might accomplish a cure which surgical means alone could effect, or else because unscrupulous persons, taking advantage of the credulousness of those associated with the movement, utilized it for their own selfish advantage.

CHAPTER V

THE SIGNIFICANCE OF THE SERPENT IN THE STATUES AND VOTIVE OFFERINGS EXPOSED TO VIEW IN THE AESCULAPIAN TEMPLES

Almost every important gallery of sculpture in Europe possesses at least one marble statue of Aesculapius, and in the majority of these the god is represented as a middle- aged or elderly man of powerful frame, having a full head of hair and full beard, and clothed only with the pallium or mantle, which is so placed as to leave the right shoulder and a large part of the chest uncovered. He holds in his right hand a knotted staff around which, in many of the statues, is coiled a serpent whose head approaches very closely to the hand. The expression of the god's counte- nance is strikingly peaceful and serene, yet without any evidence of weakness. In not a few instances other animals are represented alongside the statue, usually at the god's feet — as, for example, the cook, the owl, the eagle, the hawk or the ram — and occasionally his daughter Hygieia is shown at his side feeding the serpent. The cock is the symbol of watchfulness — a physician should be vigilant; the owl symbolizes his need of clearsightedness and of readiness to care for his patients in the night as well as during the day; the eagle has a penetrating eye and it is the emblem of long life — a benefit which the healing art is capable of procuring; the hawk was the bird consecrated to Isis, Queen of Egypt, who was believed by the Egyptians to have been highly skilled in medicine ; and the ram is the symbol of dreams and divination. Pliny says that the patients who were brought to the temple of Aesculapius were made to lie down at night wrapped in the skin of a

'-V

HEAD OF THE

MARBLE

STATUE OF

THE GOD

AESCULAPIUS

IN THE

NAPLES

MUSEUM

FIG. 4. ANCIENT STATUE OF THE

GOD AESCULAPIUS IN THE

BERLIN MUSEUM.

(From Hollander'.s Plaslik und Medizin, with the author's permission.)

SIGNIFICANCE OF THE SERPENT 63

ram, in order that they might have divine dreams. The presence of the serpent in nearly all of the statues of Aesculapius is explained in a variety of ways. Some say that this reptile, which sheds his skin once a year, is emblematic of the sick person 's need to acquire a new body, or at least cast off his old skin in the same manner as does the snake. Others consider the serpent as merely the symbol of wisdom, as it is admittedly the shrewdest and most cunning of all animals. In a few instances it is represented as drinking from a receptacle held in the hand of Hygieia. Perhaps the sculptor's intention here was to show that the serpent, although the wisest of all animals, believed that he might add to his stock of wisdom by drinking from the fountain under the control of Aescula- pius, thus conveying the impression that the wisdom of the latter was greater than his own. But all these interpre- tations are too subtle for the uneducated mind to appre- ciate at a glance. They fail also to satisfy our preconceived ideas of what such a statue should be — viz., a memorial of the godlike character of Aesculapius and of the priceless benefits which he conferred upon his fellow men, and, at the same time, an object which, when first contemplated by one who is ill, would at once evoke in that person feelings of perfect confidence in the ability and the willingness of the god represented by the statue to effect a cure. Some, perhaps even a majority, of the statues thus far recovered from the ruins of the different Aesculapian temples cer- tainly fail to arouse any such sentiments in the minds of ordinary observers ; but there are others which do in some measure accomplish this, and among the number the statue which may be seen in the Berlin Museum ancj of which a photographic copy (Fig. 4) is here reproduced, should certainly be included. The head of the god is less imposing and the expression less kindly than are these features in some of the other statues (see, for example. Fig. 5), but, to offset this, the serpent represented in the latter is of the non-poisonous variety.^ The addition of such a harm- less creature to the figure representing the god contributes

1 To save space the head of the god alone has been reproduced in Fig, 5.

64 GROWTH OF MEDICINE

nothing to the power of the statue as a whole to impress the people — i.e., the uneducated masses, as, for example, the peasants, etc. On the other hand, the significance of the poisonous snake in a statue of this character will be readily appreciated if one considers the fact that in ancient times, as it is even to-day in India, the loss of life caused by the bites of poisonous snakes was enormous. In the presence of such a fact, therefore, it would be difficult for a sculptor who was desirous of emphasizing the extraor- dinary healing powers of his hero to accomplish this more effectively than by embodying in his statue, along with other impressive features, such characters as would show him to have gained the mastery over that terribly fatal malady — the bite of the viper and of the still more deadly serpents of India and parts of Africa. Although we possess no facts which would warrant the statement that Aesculapius had been particularly successful in the treat- ment of this form of poisoning, these temple statues furnish indirect proof of a strong character that his healing power in this direction had been very great, — so great, indeed, as to have been largely instrumental in winning for him the appellation of a god. Such a striking object, especially when its more important features were commented upon by the priest who accompanied the patient on his or her first tour of inspection of temple wonders, could scarcely have failed to produce a very deep impression upon the imagination.

In the illustration which has here been reproduced (Fig. 4), a viper, as clearly shown by the shape of his head and neck and by the unusual length of the jaw, has twined himself about the staff and is close to the god's hand, so close that in an instant's time the fatal bite might readily be inflicted. But Aesculapius shows by his countenance, by the unconcerned manner in which he allows his right hand to remain near the serpent's head, and by the easy pose of his whole body, that he is not at all concerned about the danger which appears to threaten his life. In the estima- tion of the ancient Greeks this fearlessness was undoubt- edly attributed to the supernatural power which they

SIGNIFICANCE OF THE SERPENT 65

believed Aesculapius to possess over dangerous serpents as well as over diseases of all kinds.

So far as now appears, all the statues of the god that have been dug up in Greece or its nearest colonies represent the serpent as of the size commonly observed in that part of the world. HoUaender, however, furnishes (on page 118 of his work) an illustration which represents — as Ije believes — the god Aesculapius in the presence of an enormous snake, evidently a python. ( Fig. Q.) yAs this variety of serpent is not to be found in Greece, or indeed at any point further north than the Mediterranean coast of Africa, it is fair to assume that the bas-relief which depicts this scene must have been made for exhibition in an Asclepieion located at Cyrene or at the relatively near city of Alexandria, where patients, who were more or less familiar with this serpent and realized its power of crushing people to death, would have occasion to witness this suggestive work of art. And, furthermore, as if it were for the express purpose of emphasizing the great protective power of the god, the sculptor has introduced, on one side of the scene, the figures of three women, two young children and a lamb. The women nearest to the monster have folded their arms and do not manifest the least sign of fear. The children also appear to be unaware of the presence of a deadly danger. In short, the proximity of the god Aesculapius has instilled into the minds of these human beings the most complete sense of fearlessness ; he himself, as in the case of the statue of Aesculapius shown in Fig. 4, exhibiting a complete absence of fear in the presence of the dangerous monster. Neither death by poisoning nor death by constriction has any terrors for him to whom the patient is about to appeal for relief from disease.

That pythons were a terror in former times to the people who inhabited the coast regions near Cyrene is evident from a statement which Aristotle makes in his History of Animals (Book VIII., Chapter xxviii.). It reads as follows : —

In Libya (Africa) the serpents, as has been already remarked, are very large. For some persons say that, as they sailed along

66 GROWTH OF MEDICINE

the coast, they saw the bones of many oxen, and that it was evident to them that they had been devoured by the serpents. And, as the ships passed on, the serpents attacked the triremes, and some of them threw themselves upon one of the triremes and overturned it.

CHAPTER VI

THE BEGINNINGS OF A RATIONAL SYSTEM OF MEDICINE IN GREECE

With the lapse of time the religious and mystical features of the treatment carried on at the Asclepieia gave place, more and more, to rational methods, and eventually — it is scarcely possible to mention a date, but probably not many years before the Hippocratic period — these institu- tions became centres for the spread of medical knowledge of the most practical kind. This is particularly true of the Asclepieion at Cos, where Hippocrates is believed to have received his medical training. It is interesting to note that the ijaystical features of the temple treatment — features which certainly did not originate with Aesculapius himself or with his sons, Machaon and Podalirius — eventually proved powerless to stay the slow but sure advance of sound medical knowledge. Even during the period when these false elements seemed to be most strongly rooted in the temple methods, there were forces at work which in due time deprived them of much of their pernicious power. This result was inevitable, for an organization which, in order to prosper in its work of doing good to humanity, depended upon the natural superstitiousness of the people, could not possibly thrive for an indefinite length of time. That the evil results did not develop sooner than they did simply shows how powerful and stubborn is the force of superstition. In the absence of trustworthy historical evidence, hypothetical statements only can be brought forward, but there can scarcely be any doubt but that a genuine belief in the power of Aesculapius (deified) to cure disease and restore health persisted for centuries.

The custom of recording the case histories on tablets or

68 GROWTH OF MEDICINE

on the colunms of the temple, — for at this period writing was in general use, — and also that of dedicating to the god images which represented (sometimes with a remarkable degree of truthfulness) the pathological condition for which the patient sought relief, contributed very greatly to the substitution of sound learning for religious mysticism and poorly concealed humbuggery.

Among the interesting objects which may be seen at the Museum of the History of Medicine in Jena, Germany, there are several of these terra-cotta images (votive offerings) representing pathological conditions; and among them the writer noticed more particularly one which reproduced faithfully, though in diminutive size, the appearances presented by cancer of the female breast. (Fig. 7.) There were also a very carefully modeled statuette of the trunk of a woman affected with ascites, and an admirable representation of a case of facial paralysis. (Fig. 8.) These objects were obtained by Professor Meyer-Steineg on the occasion of a recent visit to the ruins of the temple of Cos and other similar ruins in Greece and Asia Minor. The British Museum possesses many objects of the same character.

It is not known at what precise date the iatreia, or small private hospitals, first made their appearance, but it was about the time when the religious character of the thera- peutic work done in the Asclepieia gave place to treatment of a more distinctly medical character. Then, in addition to these iatreia, there were schools for gladiators and institutions in which gymnastic exercises were zealously cultivated ; and in these places there was a frequent demand for advice in regard to questions of diet, and for surgical aid in the setting of broken bones, the reducing of dis- locations, and the curing of bruises and sprains. As may readily be understood, the Asclepieia could not furnish the sort of professional aid which these institutions needed, and thus a further stimulus was given to the complete separation of the two kinds of medical practice — that connected with the temple and that conducted by outside physicians.

jS£BC-"w»-

I i(.. o. BAS-RELlKi- (;i- AESCULAPIUS. ACCOMPANIED BY WOMEN

AND CHILDREN, IN THE PRESENCE OF AN

ENORMOUS SERPENT.

The original is in the National Museum at Athens.

FIG. 7. FEMALE BUST SHOWING CANCER OF ONE BREAST. (Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)

BEGINNINGS OF A RATIONAL SYSTEM 69

In Plato's ''Republic" (Book III., Chapter 15) mention is made of a certain Herodicus (of Selymbria; about 450 B. C.) who effected many cures by a method of treat- ment which combined athletic exercises with dieting. He gained considerable celebrity in this way, and is undoubt- edly entitled to the credit of having been the first to call serious attention to the value of this plan of treating certain maladies. But, unfortunately, he made use of it in not a few instances where it proved harmful rather than beneficial to the patient, and thus brought discredit upon the method.

Already previous to the time at which the changes mentioned above took place, there had occurred still other changes in the character and practice of medicine. The business of cutting for stone in the bladder, for example, had been left entirely in the hands of men who made a specialty of this branch of medicine — men who might truthfully be called medical artisans. Then there was another class of men who devoted their energies to col- lecting medicinal roots and plants. They were a necessity to physicians, and constituted the first representatives of the modern apothecary. Still another change in the status of the Greek physicians had been slowly developing throughout this pre-Hippocratic period, a change which tended more and more to make them men of self-reliance and of considerable importance in their respective com- munities, and which indicated very clearly that they were steadily growing in skill and breadth of knowledge. As evidence of the correctness of this statement it is sufficient to mention the fact that Greek physicians had established so good a reputation that they were frequently called to see important cases at a great distance — in Egypt, in Persia, etc. But before further consideration is given to this subject of the development of the Greek physician during the period immediately preceding the appearance of the Hippocratic writings, it seems advisable to say a few words concerning the facilities for medical instruction which were available at that time.

Medical Instruction in Connection with the Asclepieia. —

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It does not appear clearly in any of the published descrip- tions of these ancient Greek sanatoria just what were the relations between the priests and the men who utilized all this rich clinical material — records of all sorts of diseases, and the means (other than religious) employed in treating them, pictures or plastic reproductions of the visible pathological lesions, etc. — for the purpose of instructing the younger men who contemplated engaging in the practice of medicine. The modern teachers of the art know very well how difficult is the task of combining in a satis- factory manner these two things — the safeguarding of the patient's interests and the utilization of their maladies as object lessons for men who are preparing to cure or relieve the bodily ills of those who may at some future moment need their professional services. To them, therefore, it would be a matter of very great interest to learn how this difficult problem had been solved nearly twenty-five hundred years ago. But, unfortunately, no satisfactory data upon which a trustworthy account might be founded are obtainable, and we are obliged to fall back upon such aid as our imagination may furnish. From Puschmann's work on medical teaching in ancient times the following statement relating to the subject has been taken : —

The priests in the Aesculapian temples were not, as is generally assumed, physicians in the ordinary sense. They may have acquired some knowledge of the art, and they may even in some instances have been regularly trained physicians, but the important fact remains that they wished it to be understood that the treatment carried out in the temple was in accordance with revelations made to them by the god Aesculapius, and not the mere fruit of human knowledge. Consequently the intervention of regular physicians in the temple management of the sick must have appeared to them quite superfluous. For this reason, therefore, it is not likely that there existed, on the part of either the temple priests or the physicians, any feeling of animosity or opposition. It is more likely that the contrary was the case, for the evidence shows that the physicians — the Asclepiadae — paid most humble reverence to the sacred relics of Aesculapius, and placed the most implicit confidence in the opinions which he was supposed to give in desperate cases.

70 -

FIG. 8. PARALYSIS OF THE LEFT FACIAL NERVE.

(Courtesy of Prof. Dr. Meyer-Steinegr, Jenaer medi- zinisch-hislorische Beiirage, Heft 2, 1912.)

BEGINNINGS OF A RATIONAL SYSTEM 71

While Puschmann does not say to what period in the history of these temples his statement applies, it is safe to assume that he had in mind only the earlier stages. When the systematic teachings of medical pupils began, those physicians who gave the instruction — ^viz., the Ascle- piadae who were not at the same time priests — took up their abode somewhere in the neighborhood of the temple. Thus, medical schools were formed at different places, those of Rhodes, Crotone, Cyrene, Cos and Cnidus attaining the greatest celebrity. The pupil paid a fee for his instruction, and when his training was believed to be completed he was admitted into the association or brotherhood of the Asclepiadae upon taking the following oath, which for ages past has been known as **The Hippocratic Oath,'* but which is now believed to have been formulated long before the time of Hippocrates : —

THE HIPPOCRATIC OATH

I swear by Apollo the Physician and Aesculapius, and Hygieia and Panacea and all the gods and all the goddesses — and I make them my judges — that this mine oath and this my written engage- ment I will fulfil as far as power and discernment shall be mine.

Him who taught me this art I will esteem even as I do my parents; he shall partake of my livelihood, and, if in want, shall share my goods. I will regard his issue as my brothers and will teach them this art without fee or written engagement if they shall wish to learn it.

I will give instruction by precept, by discourse, and in all other ways, to my own sons, to those of him who taught me, to disciples bound by written engagements and sworn according to medical law, and to no other person.

So far as power and discernment shall be mine, I will carry out regimen for the benefit of the sick and will keep them from harm and wrong. To none will I give a deadly drug even if solicited, nor offer counsel to such an end ; likewise to no woman will I give a destructive suppository; but guiltless and hallowed will I keep my life and mine art. I will cut no one whatever for the stone, but will give way to those who work at this practice.

Into whatsoever houses I shall enter I will go for the benefit of the sick, holding aloof from all voluntary wrong and corruption, including venereal acts upon the bodies of females and males

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whether free or slaves. Whatsoever in my practice or not in my practice I shall see or hear amid the lives of men which ought not to be noised abroad — as to this I will keep silence, holding such things unfitting to be spoken.

And now if I shall fulfil this oath and break it not, may the fruits of life and of art be mine, may I be honored of all men for all time ; the opposite if I shall transgress and be forsworn.

(Translated from the Greek by the late John G. Curtis, M.D., of New York.)

While at first, according to Puschmann, many physicians did not belong to the Aesculapian Brotherhood, there came a time when all were known as Asclepiadae.

Influence of the Schools of Philosophy on the Growth of Medical Knowledge. — About the beginning of the sixth century B. C. there developed, in Greece and its colonies, schools of philosophy which exerted a most excellent influence upon the growth of medicine. The first of these was the one known as the Ionian School, whose founders and chief representatives were Thales, of Miletus in Ionia (born in 640, died in 548 B. C), and his pupils Anaximander and Anaximenes. The guiding principle of these men was to study natural phenomena and to learn, if possible, their causes and the laws of their action. Physiology, therefore, became one of their special studies, and thus they con- tributed to the laying of one of the most important foundation-stones of medicine. Thanks to the good quality of the work of instruction that had thus far been carried on at Cos, Cnidus, and other Asclepieia, medicine had by this time reached a sufficient degree of development for its devotees to derive a full measure of benefit from the new teaching of the philosophers. Well grounded in the observation of disease in its different forms and modes of behavior, and also familiarized with the ordinary methods of treatment, these physicians needed to be shown a new route along which they might advance to greater heights of knowledge, and they also needed to be stimu- lated to further endeavor. The introduction of the new school accomplished both of these purposes. It taught the men of the older organizations that they must make much

BEGINNINGS OF A RATIONAL SYSTEM 73

greater use of their reasoning powers than they had hitherto done, and at the same time, through the creation of a group of rival physicians, it supplied them with the required stimulus. Another important school of philosophy was that known as the Eleatic School, which flourished at Elea, in Lower Italy, its leaders being natives of that city. The most prominent men connected with this school were Parmenides (born about 540 B. C.) and Xenophanes of Colophon, in Asia Minor, whose contributions to mental science formed the basis of Plato's metaphysics.

The period roughly embraced between the years 500 and 300 B. C. represents the most brilliant age of Greek intellectual and artistic activity. During this time there came into prominence such philosophers, historians, poets, physicians, artists and generals of armies as had never before been marshaled in historic array in so rapid succession. Even at this late day the names of these great men are almost household words — such names, for example, as Pythagoras, Alcmaeon, Anaxagoras, Aristotle, Plato, Socrates, Sophocles, Aeschylus, Euripides, Aristophanes, Pindar, Xenophon, Demosthenes, Democedes, Hippocrates the Great, Phidias, Praxiteles, Zeuxis, Apelles, Darius I., Alexander the Great, and many others of almost equal celebrity. During the centuries immediately preceding this golden age of Greek history, there seem to have been very few men of great merit in any of the branches of learning or in the fields of war or art, but this impression is certainly false. It is doubtless to be explained by the fact that large quantities of documentary evidence relating to these years have been entirely lost. Daniel Le Clerc, for instance, states^ that, of the separate histories of the descendants of Aesculapius which were written by Eratos- thenes, Pherecydes, ApoUodorus, Arius of Tarsus and Polyanthus of Cyrene, not one has come down to our time. If, then, in the single department of medicine, the destruction of documentary evidence was as great as is here represented, how enormous must have been the loss of precious historical materials in all the departments

1 Histoire de la Medecine, Amsterdam, 1723.

74 GROWTH OF MEDICINE

of human activity taken together. We may, therefore, safely assume that this golden age, which lasted only about two hundred years, represents simply the culmination of an even longer period of slow but steady development, a period of creditable though perhaps less brilliant achievements.

Of the names mentioned above there are several that belong to men who were in various ways connected with the early history of medicine. Pythagoras, for example, is said to have been one of the first among the Greek philoso- phers to exert a strong and double impression upon the medical teaching of that period. He was born in the Island of Samos, near the coast of Asia Minor, about the year 575 B. C. After spending several years in Egypt for purposes of study, and probably visiting Babylon, at' that time a great centre of learning and of artistic cultivation, he established at Crotona, in the south of Italy, a schooP where natural philosophy, mathematics, acoustics, etc., were taught. He also devoted some attention to anatomy, to embryology, to physiology and to therapeutics. Accord- ing to his views of what constituted hygienic living a man should accustom himself to a diet of the simplest character, without meat. Pythagoras was a believer in the Chaldean doctrine that the uneven numbers possess a more important significance than the even, and that the number seven in particular has a special relationship to the phenomena of certain diseases; the crisis frequently falling on the seventh, fourteenth, or twenty-first day. Galen, it is said, expressed surprise that a man as sensible and learned as Pythagoras should have paid any attention to such trifles. Not a few of the disciples of Pythagoras were physicians,

2 The word ' ' school, ' ' when employed in the strictly modern sense of that term, means an establishment regularly organized for the purpose of giving instruction. Here, however, it is intended to signify simply that certain places, like Cos, Crotona, Cnidus, etc., had become the rendezvous of men who desired to cultivate — some as teachers, others as disciples or pupils — certain branches of knowledge, or certain doctrines. At a later period (third century B. C.) there was established at Alexandria, Egypt, a well-organized school of medi- cine closely resembling those of modern times.

BEGINNINGS OF A RATIONAL SYSTEM 75

and when the brotherhood (if such it may be called) broke up, as it did in the fifth century B. C, these men traveled about from one Grecian city to another; from which fact they were given the name of * * periodeuts " or ambulant physicians. Crotona was also celebrated as the birthplace of Milo, the athlete.

Democedes, who was a contemporary of Pythagoras, but not one of his disciples, was a native of Crotona. Dion Cassius, the author of a Roman history, ranks him and Hippocrates as the two most eminent physicians of antiquity. Daremberg, who derived his facts from the works of Herodotus, gives the following account of the adventures of Democedes : —

Being unable to bear any longer the frequent anger and harsh treatment of his father, Calliphon, Democedes left Crotona, and settled in practice at Aegina, on the Saronic Gulf, not far from Athens. Almost from the very start he attained marked success, and already in the second year of his residence in Aegina he was made the recipient of a pension of one talent (equal to about £240. or $1200.) out of the public treasury. During the following year he was induced, by the offer of a larger pension (100 minae, or about $3000.) to settle in Athens; and, a year later, he accepted a still larger remuneration from Polycrates, the tyrant of Samos. Having accompanied the latter on a trip to Sardis, the capital of Lydia, in Asia Minor, he fell a prisoner into the hands of the governor of that city, and was made by him a slave. Not long afterward Darius gained possession of this governor's or satrap's property, including all his slaves; and thus, despite all his efforts to conceal his profession through fear that a knowledge of it on the part of the king might prolong his bondage indefinitely, Democedes was unable to do so. The discovery came about in the following manner. During a hunting trip Darius broke his ankle. He called to his assistance the court physicians, who were esteemed the most skilful that could be found in all Egypt, but they failed to give him relief. By the violence of their manipulations they rather made matters worse. For seven days and nights his sufferings were so great that he was unable to obtain any sleep. Finally, on the eighth day, one of the court attendants having told Darius that there was a Greek physician among the slaves, Democedes was sent for, and he appeared before the king clad in

76 GROWTH OF MEDICINE

rags and with chains on his ankles. When asked whether he knew anything about medicine he denied such knowledge, being fearful that the discovery of the truth about himself would stand in the way of his ever getting back to Greece. Darius, perceiving that he was dissimulating, ordered the attendants to fetch the whips and pinchers. Whereupon Democedes made up his mind that he had better confess the truth. He accordingly told the king that, while not possessing a thorough knowledge of the healing art, long association with a physician had familiarized him more or less with the subject. The king then asked him to take charge of the case. Democedes, following the treatment adopted by the Greek physicians in similar conditions, applied soothing remedies and soon succeeded in procuring sleep for the suffering king. Event- ually he obtained a complete cure, and Darius, who had made up his mind that he would never again be able to use his limb, was naturally delighted with the result. He loaded Democedes with gifts, and, being charmed with his conversation, made him sit at the royal table and did everything possible to render court life attractive; but liberty was denied him, which was the one thing that Democedes most ardently desired. The only use which the latter made of the great influence which he had obtained over Darius was to save the Egyptian physicians from the death by crucifixion which the king had decided to inflict upon them for their lack of skill.

The means of escape finally presented themselves to Democedes in a most unexpected manner. Atossa, who was the wife of Darius and also the daughter of Cyrus, was afflicted with a swelling of the breast which developed into an abscess and began to burrow into the neighboring tissues. After, for a time, concealing the trouble through a sense of false modesty, she made up her mind to consult Democedes. He had the good fortune to cure her of this malady in a relatively short time. As preparations were then being made to send a number of spies to Greece with instructions to examine the coast carefully for the purpose of determining at what points the defenses were sufficiently weak to render an attack by the Persians reasonably sure of success, Democedes asked permission of Darius to accompany these men as their guide. His request was granted; and, as soon as the expedition reached Tarentum in Calabria, he delivered the Persian spies into the hands of Aristophilides, the king of that country, and then fled in all haste to Crotona, his native city. Shortly afterward these Persians, having been set at liberty by Aristophilides, made the

BEGINNINGS OF A RATIONAL SYSTEM 77

attempt to capture Democedes and carry him off by main force, but the citizens of Crotona thwarted the attempt and compelled the men to return to Asia. Democedes then married the daughter of Milo, the athlete, and history furnishes no information regarding the subsequent career of this extraordinary man.

Daremberg calls attention to certain excellent proverbs which may be found in the writings of the Greek poets and which are of some interest to physicians. The following may serve as examples of those most widely known : — *

Joy is the best physician for fatigue.

(Pindar, 522-442 B. C.)

The good physician is he who knows how to employ the right remedies at the proper time ; the poor one, he who, in the presence of a serious illness, loses his courage, becomes flustered, and is unable to devise any helpful method of treatment.

(Aeschylus, 525-456 B. C.)

Physician, heal thyself.

(Euripides, 400-406 B. C.)

Advice given to Phaedra by her nurse :-

If thou hast some ailment which thou dost not care to reveal to men, here are women who are competent to treat the condition properly.

(Euripides.)

Sleep is the physician of pain, and

Death is the supreme healer of maladies.

(Sophocles, 495-406 B. C.)

In Plato's writings there are to be found a few passages in which this philosopher gives his views in regard to certain matters that are not without interest to modern physicians. The following extracts are of this nature: —

There is not then, my friend, any office among the whole inhabi- tants of the city peculiar to the woman, considered as a woman,

3 All of these are translations from the French.

78 GROWTH OF MEDICINE

nor to the man, considered as a man; but the geniuses are indiscriminately diffused through both: the woman is naturally- fitted for sharing in all offices, and so is the man; but in all the woman is weaker than the man.

Perfectly so.

Shall we then commit everything to the care of the men, and nothing to the care of the women ?

How shall we do so ?

It is therefore, I imagine, as we say, that one woman, too, is fitted by natural genius for being a physician, and another is not ; one is naturally a musician, and another is not.

(From "The Republic" of Plato, translated by Spens.)

But tell me with reference to him who, accurately speaking, is a physician, whom you now mentioned, whether he is a gainer of money or one who taketh care of the sick? and speak of him who is really a physician.

One who taketh care, said he, of the sick.

***********

Why then, said I, no physician as far as he is a physician, con- siders what is advantageous for the physician, nor enjoins it, but what is advantageous for the sick; for it hath been agreed that the accurate physician is one who taketh care of sick bodies, and not an amasser of wealth. Hath it not been agreed ?

He assented.

(Plato, 428-547 B. C, translated by Spens.)

But Plato 's knowledge of huinan anatomy and physiology was very crude and in some instances decidedly fanciful. In corroboration of this statement the following extract from the * ' Timaeus ' ' may be quoted : —

And on this account, fearing to defile the Divine nature more than was absolutely necessary, they [the junior gods] lodged man's mortal portion separately from the Divine, in a different receptacle of the body; forming the head and breast and placing the neck between, as an isthmus and limit to separate the two extremes.

In the breast, indeed, and what is called the thorax, they seated the mortal part of the soul. And as one part of it was naturally better, and another worse, they formed the cavity of the thorax into two divisions (resembling the separate dwellings of our men and women), placing the midriff as a partition between them. That part of the soul, therefore, which partakes of fortitude and

BEGINNINGS OF A RATIONAL SYSTEM 79

spirit and loves contention they seated nearer the head between the midriff and the neck ; as it is the business of the reason to unite with it in forcibly repressing the desires, whenever they will not obey the mandate and word issuing from the citadel above.

The heart, which is the head and principle of the veins as well as the fountain of the blood that impetuously circulates through all the members, they placed in a kind of sentry-house, that, in case of any outburst of anger, being informed by the reason of any evil committed in its members, owing either to some foreign cause, or else internal passions, it (the heart) might transmit through all its channels the threatenings and exhortations of reason, so as once more to reduce the body to perfect obedience, and so permit what is the best within us to maintain supreme command.

But as the gods foreknew, with respect to the palpitation of the heart under the dread of danger and the excitement of passion, that all such swellings of the inflamed spirit would be produced by fire, they formed the lungs to be a sort of protection thereto; first of all, soft and bloodless, and next internally provided with cavities perforated like a sponge, in order to cool the breath which they receive, and give the heart easy respiration and repose in its excessive heat. On this account, then, they led the channels of the windpipe into the lungs, which they placed like a soft cushion round the heart, in order that when anger rises in it to an extreme height it might fall on some yielding substance, and, so getting cool, yield cheerfully and with less trouble to the authority of reason.

(Plato's "Timaeus," translated by Henry Davis.)

Alcmaeon, Empedocles, Diogenes of Apollonia, Anaxa- goras and Pausanias, whose names are mentioned above in the list of eminent men who flourished during the golden age of Greek history, are entitled to further consideration. Alcmaeon of Crotona was a contemporary and disciple of Pythagoras. He was specially devoted to the study of anatomy and physiology, and is credited with the distinc- tion of having been the first person to dissect animals for the purpose of learning the formation of the different parts of their bodies. With the exception of a few fragments that are to be found scattered throughout ancient medical literature, Alcmaeon 's writings have all been lost. The discovery of the optic nerve is credited to him, and

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Neuburger states that he deserves still greater credit for having been the first to declare that the brain is the central organ of all intellectual activity.

Of all the disciples of Pythagoras, Empedocles attained the greatest celebrity. He flourished about 444 B, C, his residence being at Agrigentum, in Sicily. Much of his reputation appears to have been due to the mystery which surrounded many of* his actions. He was even reputed to have brought again to life persons who were believed to be dead. His works were all in verse, but only fragments have come down to us. He placed the seat of hearing in the labyrinth of the temporal bone. His death occurred in Peloponnesus at the age of sixty, as the result of an accident.

Anaxagoras was born at Clazomenae, in Ionia, 500 B. C. He was the teacher of Euripides, the Athenian poet, and Pericles, the greatest of Athenian statesmen. He and his contemporary, Diogenes of Apollonia, in Crete, devoted a great deal of attention to the study of anatomy. They dissected animals and made some genuine discoveries; Anaxagoras noting the existence of the lateral ventricles of the brain, and Diogenes furnishing a description — ^very erroneous, it is true — of the vascular system of the body. Puschmann says that, according to Aristotle, the philoso- phers of that period considered the study of man and his diseases the most important one to which they could devote their time and thoughts. Many of them indeed had been educated as physicians, and not a few were actual practitioners of medicine.

CHAPTER VII HIPPOCRATES THE GREAT

Hippocrates was bom in 460 B. C. in the city of Cos, on the island of the same name. Both his father and grand- father were eminent physicians, descendants of Aescu- lapius. On his mother's side he traced his descent from Hercules. The famous painter, Apelles, also hailed from the city of Cos. To distinguish Hippocrates from an earlier individual of the same name he was called Hippocrates II., or the Great. He is said to have received his first instruction in medicine at the school of the Asclepiadae in his native city, but his frequently repeated and very favorable comments on the teachings of the Cnidian schooP have led some to believe that he may have received a part of his medical training at the latter institution. At a later period of his life his popularity as a teacher of medicine, in the school of the Asclepiadae at Cos, attracted many pupils to that city. In accordance with a custom which prevailed among the physicians of ancient Greece, Hippocrate^, at the beginning of his career, spent quite a long time in Athens, and then traveled about, from one city to another, in the character of a periodeutic or itinerant physician. In this way, as he himself reports in some of his writings, he visited Thessaly, Thrace, the Island of Thasos, Scythia, the countries bordering on the Black Sea, and even Northern Egypt. Owing largely to domestic troubles he left his home in Cos, during the latter part of his career, and removed to Thessaly. He died about 370 B. C. at Larissa, at an

1 The city of Cnidus was situated very close to the Island of Cos, on a peninsula that projects from the coast of Caria, Asia Minor.

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advanced age. Soranus of Ephesus, the celebrated obstetrician, reported that in his time (second century A. D.) the tomb of Hippocrates was still standing, and that it had been taken possession of by a swarm of bees whose honey was far-famed for its efficacy in curing ulcers of the mouth in children.

Among the pupils of Hippocrates were his two sons, Draco and Thessalus, and his son-in-law, Polybus. Thessalus, in the capacity of a military surgeon, accom- panied Alcibiades on his expedition to Sicily, and later in his career he served as private physician to Archelaus, King of Macedonia. It is also believed that a number of the writings in the Hippocratic collection are from his pen. On the other hand, it is a well-established fact that Polybus is the author of a few of these treatises. When Hippocrates gave up the work of teaching, his son-in-law, who was at that time engaged in private practice in Cos, was chosen his successor in the school.

Among the many anecdotes which are related of Hip- pocrates, there is one which may with propriety be repeated here : —

On the occasion of a visit to Abdera, in the northern part of _ Thrace, Hippocrates was requested to examine into the mental condition of the philosopher Democritus, who was thought by his narrow-minded countrymen to be insane. Hippocrates found him deeply engrossed in the study of natural philosophy and asked him what he was doing. Democritus replied that he was investigating the foolishness of men. Whereupon Hippocrates reported that he considered Democritus the wisest of men. (Pagel.)

No better evidence of the true greatness of a man can be furnished than that which is afforded by the praise of his contemporaries in the same rank or walk of life ; and when the appreciation comes from such men as Plato and Aristotle, it constitutes an absolute guarantee that it is well and honestly earned. To Hippocrates belongs the singular honor of having won unstinted praise from both of these great philosophers, Aristotle giving him the title of ''Hippocrates the Great," and Plato comparing him

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to those famous sculptors, Polyclytus and Phidias. His writings and those of the members of his family who were associated with him in the work of promoting a knowledge of medicine were most carefully preserved by his successors. When the Ptolemies began to establish libraries at Alex- andria, Egypt (285 B. C), and manifested a decided readiness to purchase the works of the most celebrated authors, copies of the Hippocratic writings were among those which found their way to that city. This eagerness on the part of the Kings of Egypt to purchase books or manuscripts stimulated unscrupulous persons to attribute to celebrated authors not a few of these works which they offered for sale. The librarians, whose duty it was to guard against such frauds, were not sufficiently well informed to prevent them; and thus there were accepted, as genuine productions, a few books which could not possibly have been written by those to whom they were attributed. The collectiou of Hippocratic writings did not escape this fate, and the evil was also further aggravated by the fact that copyists and incompetent editors made all sorts of emendations and additions on their own respon- sibility. Thus, it is not surprising that a collection which originally contained only the writings of Hippocrates and his immediate family, should in course of time have become expanded, not only by such alterations as have just been described, but also by the addition of entire works that had been written by others. At the beginning of the third century B. C, the Ptolemies appointed a committee of learned men in Alexandria to examine carefully the treatises reputed to be the work of Hippocrates and to make a collection of those which appeared to them to be genuine. They performed this task to the best of their ability, but the result showed that they lacked the necessary critical powers; and consequently during the past 2000 years repeated attempts have been made to do what they failed to accomplish, but these efforts have only succeeded in part. The French edition prepared by Emile Littre, the distinguished member of the French Academy of Medicine, and published in the years 1839-1861, was, until quite

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recently, universally accepted as embodying the best results of modern research and criticism with regard to this difficult question. But since 1861 other scholars have been busily engaged in perfecting the text of the Hippocratic writings, and their criticisms and suggestions have made it possible to publish a German version of this great work which is of more practical value to physicians than that of Littre, which forms a series of ten large volumes and is no longer easy to obtain. On the other hand, the German version by Robert Fuchs (Munich, 1895-1900), in three volumes of moderate size, while in no respect inferior to the famous French translation, is superior to it in several particulars: it is better adapted to the needs of the ordinary practitioner of medicine, it embodies the results of the excellent critical work done since 1861 {e.g., by Ermerins of Utrecht, Daremberg of France, and Ilberg and Kiihlewein of Germany), and it costs very much less than its French predecessor and rival.

As regards the question of authenticity of the treatises contained in the work known as *'The Hippocratic Writ- ings" the most important thing to be determined is, not whether this or that book or chapter in the collection was really written by Hippocrates, but whether the work in its totality gives a correct and fairly complete picture of the best medical thought and practice of the period during which Hippocrates lived; and to this question a decided answer in the affirmative may be given. As to the broad question of authenticity. Max Neuburger, the distinguished Viennese author of the latest and most authoritative history of medicine, thus expresses himself : —

Notwithstanding the extremely small quantity of evidence which the so-called ''Hippocratic Writings" themselves furnish as to who were the writers of the individual treatises and as to what Hippocrates himself actually did or thought; and although it is true that portions of the collection often contradict one another both in regard to questions of theory and also in regard to methods of treatment, one fact stands out conspicuously, viz., that the peculiar character of these writings both as a collection and taken separately, not only gives them a unique position in medical

HIPPOCRATES THE GREAT 85

literature, but reveals plainly that they owe their origin directly or indirectly to the powerful influence of a single commanding personality.

As to the manner of teaching medicine, the Hippocratic writings show that, at the time which is here under con- sideration, the mystical features had almost completely disappeared. The science was now taught by regular instructors, who agreed for a stipulated fee to take charge of the pupil's entire training from the beginning to the end of the course. Candidates who were in delicate health were discouraged from entering upon the career of a physician, and those who had completed the regular course of instruction were sent out into the world equipped with certain general principles for their future guidance in actual practice. Some of these bear a close resemblance to the principles of a similar nature which had been established at a much earlier period in India. For example, the importance of cleanliness of the person is strongly emphasized. Reticence, as well as courtesy, is classed as one of the virtues of a good physician.

He who acts hastily and does not take sufiBcient time for consideration is sure to be criticised unfavorably. If he breaks out too readily into laughter he will be thought uncultivated.

In another of the Hippocratic writings the physician is urged not to indulge in too much small talk, but to confine his conversation as much as possible to matters relating to the treatment of the disorder.

In his business dealings the physician, like a genuine philosopher, should not display a greed for money, he should assume a modest and dignified attitude, he should appear quiet and calm, and his speech should be simple and straightforward and free from all superstition.

For their knowledge of human anatomy the physicians of that period were obliged to depend on the dissection of animals. Specimens of human bones were of course easily accessible, and consequently the descriptions which are

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given of these structures are quite accurate, even as regards many of the finer details.

It would be a very difficult matter to furnish here, within a limited space, a reasonably clear exposition of the views held by Hippocrates with regard to human physiology and pathology. Empedocles, a Greek physician and high priest of Agrigentum, in Sicily, who was born about 490 B. C, founded a system of philosophy on the theory that the universe is made up of four elements — fire, air, earth and water; and he maintained that fire is the essence of life, the other elemei^ts forming the basis of matter. It was upon this system that Hippocrates founded his own theories of life, death and disease, but he disagreed with Emped- ocles in regard to the manner in which the four elements are united, his own belief being that they form together a genuine mixture, whereas Empedocles maintains that their union represents merely a mechanical aggregation of separate atoms. He also held that these original four elements, to which he gave the names of heat, cold, dryness and moisture, were represented in the human body by the following four cardinal fluids or '^ juices": blood, mucus or phlegm, black bile and yellow bile.^ He maintained, further, that when these elements are mingled harmo- niously so as to produce a state of perfect equilibrium, health resulted; but that when some deficiency of one or more of them, or some lack of harmony between them in other respects, occurs, disease is produced. At a later date, a fifth element — wind or air (pneuma) — ^was added to the other four; and when Hippocrates was unable to account satisfactorily for certain phenomena of disease, he was wont to refer the phenomenon observed to divine interference.

This brief exposition of the physiological and patho- logical views held by Hippocrates, incomplete and super- ficial as it is, mil have to suffice. Those who wish to acquire a more profound knowledge of the subject should consult some of the larger treatises like those of Darem-

2 Black bile, it was believed, comes from the spleen, while the yellow variety is a product of the liver.

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berg, of Max Neuburger, and of Pagel, as well as the sections devoted to these subjects in the French (Littre) and the German (Fuchs) versions of the Hippocratic writings. At every step in such a study, the modern physician will encounter ideas and individual terms which he will have great difficulty in comprehending; and later on, as he reads the sections which deal with the more practical matters of the medical art, he will be astonished to find that Hippocrates was a most acute and trustworthy observer of the phenomena of disease, a remarkably clear writer, and a standard-bearer of very high aims.

In the examination and treatment of the sick the physi- cians of ancient Greece were highly trained. They paid very close attention to the patient's account of his symptoms, but it was to the physical examination of the diseased body that they attached the greatest importance. They noted with extreme care the color and other peculiari- ties of the skin and mucous membranes, the condition of the abdomen, and the shape and movements of the thorax ; they tested the patient's temperature by placing the hand upon the body ; and all the excretions were subjected to the closest scrutiny. By means of palpation they were able to determine not only the size of the liver and spleen, but also the changes which occur in the form of these organs in the course of certain diseases. They utilized succussion both as an aid to diagnosis and as a means of favoring the breaking through of pus into the bronchial tubes. They were familiar with the pleuritic friction sound and with the finest rales, which they compared to the • creaking of leather or ''the noise of boiling vinegar." In their descriptions of these sounds it is distinctly stated that the examiner's cartas kept tightly pressed against the patient's chest. ^

In speaking of the accounts of individual diseases which appear in the Hippocratic writings, Puschmann says that they are evidently based 6n cases actually observed in practice, and that they are admirably written. It is in the laws which they have laid down with regard to the treat- ment of disease, however, that the Hippocratic writers have

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gained their chief distinction, a distinction which will belong to them through all time.

The physician should be the handy man of Nature, and he should strive to aid and to imitate her efforts to effect a cure. His first care should be to remove, so far as is possible, the causes of the disease ; and then, in the conduct of the treatment, he should keep in view at all times the special circumstances of the case, giving closer attention to the patient than to the disease itself. In short, he should aim at being useful, or at least he should be careful not to do any harm.

1^

CHAPTER VIII

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

The statements which have thus far been made in these pages with regard to Hippocrates are only of a general character, and it may therefore be interesting for the reader to have placed before him a few selected extracts from the writings which have formed the basis of these statements. The English text here used is a translation of the German version of Robert Fuchs, to which reference has already been made. It would have been a pleasure to use for this purpose the admirable English translation of Frederick Adams, published in 1849 under the auspices of the Sydenham Society of Great Britain; but, unfortu- nately, this version contains only a part of the Hippocratic writings, and, besides, this writer did not at that time have the advantage of consulting the French and German versions which have been published since 1849.

It seems almost unnecessary to state here, by way of preface, that the small amount of space which may properly be devoted to these extracts renders it necessary to present many of them in a very fragmentary and disconnected form, merely enough text being furnished to give the reader some slight idea both of the manner in which Hippocrates and those associated with him handled certain medical topics, and also of the views which they entertained with regard to the same subjects.

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

Aphorisms. — I. — 1. Life is short, art is long, the right moment lasts but an instant,^ experience is often deceptive, a correct judgment is hard to reach.

1 Daremberg (Hist, de la Mid.) makes the following comments on this

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6. For the most serious ills extreme measures cautiously- employed are the best.

8. When an illness has reached its acme the lightest diet must be prescribed.

11. During the exacerbations nourishment should be withheld, for at these times the giving of food is harmful; and in illnesses which are characterized by periodic paroxysms it is also best not to give food during the paroxysms.

13. Old people bear fasting very well, and the same is almost true of persons of mature age ; but young individuals do not bear abstinence from food so well, and this is particularly the case with children, especially with those of a lively disposition.

24. In acute illnesses laxative remedies should rarelv be admin- istered, and then only in the early stage of the malady and with great caution.

II. — 2. When sleep puts an end to delirium it is a good sign. 3. When either sleep or wakefulness oversteps the proper limit it is harmful.

5. Causeless depression is an indication of some disorder.

19. In acute diseases the prognosis as regards either death or recovery, is very uncertain.

44. Corpulent persons are more likely than those who are slender to die a quick death.

V. — 7. When epileptic attacks occur before the age of puberty, a change for the better may be looked for ; but if the disease makes its first appearance when the individual has already reached his twenty-fifth year, he may be expected to carry the affliction with him to the time of his death.

9. Consumption most commonly attacks persons who are between the ages of eighteen and thirty-five.

14. When a consumptive person has attacks of diarrhoea, a fatal issue may be anticipated.

VII. — 1. If in the course of an acute illness the extremities grow cold, it is an unfavorable sign.

sentence: "How many are the occasions when we physicians would have it in our power to avert death, or at least to postpone it for a few hours, if we would only engrave upon our memories these words of the old man of Cos I 'What a cruel responsibility rests upon those whose duty it is to summon the doctor at the proper moment! And how great must be the remorse if he fails to arrive in time ! ' On the other hand, how wise is the remark of Celsus : 'The best practitioner is he who never loses sight of his patients.' "

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14. If, after a blow upon the head, stupefaction or delirium manifests itself, the outlook is bad.

[The total number of the aphorisms is 422.]

The Book of Prognoses. — 1. I believe that it is best for a physician to acquire a certain degree of practice in the power to predict how the disease is likely to terminate ; for if, when he is in -the presence of his patient, he is able to state, not only what is going to take place in the future course of the malady, but also certain other facts which relate to the past behavior of the attack, but which were omitted from the account given to him of the previous history of the case, he will impress the patient with the belief that he is thoroughly familiar with the disease from which the latter is suffering, and that consequently he is a physician in whose knowledge and skill he can place entire confidence. Then, besides, he will be the gainer in another respect: his knowledge of what is likely to be the subsequent course of any given disease will enable him to treat it in the most effective manner. The ability to restore all his patients to health would of course be a greater power than that of correctly predicting the future behavior of a malady in any particular case. This ability, however, is clearly unattainable. One patient dies by reason of the severity of the disease itself, even before the physician is called in; a second one, shortly after the latter 's visit; and a third lingers on for a day or two after the doctor's arrival, dying before the latter 's art has had time to produce a beneficial effect in hindering the advance of the malady. The observation of these different events should enable the physician to become acquainted with the nature of the diseases observed, and — more particularly — to learn to what extent, in individual instances, they manifest a strength greater than the patient's power of resistance. At the same time, he must not forget that in many cases divine interference plays a part in directing the course of the disease. And thus, if he pays heed to all these things, the physician will merit the confidence of his patients and will gain the reputation of being a clever and skilful practitioner.

IV. — It is better when the physician, upon the occasion of his first visit, finds the patient lying upon one side, with his hands, neck and thighs slightly flexed, and the entire body placed in a perfectly natural position, like that which a man assumes in bed when he is in a state of health. It is not so well when the physician finds the patient lying upon his back, with his hands, neck and

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thighs extended. But if the latter is found curled up and sliding down toward the foot of the bed, this is an unfavorable sign. Finally, if he is found with rather cold feet projecting from under the bedclothes, and with his arms outstretched and his neck and thighs exposed, his condition may be considered dangerous, for this attitude of the body betokens an agitated state of the mind. If the patient sleeps with his mouth constantly open, lying upon his back and with his thighs strongly flexed and widely separated, it may be assumed that death is near at hand. If he lies upon his belly when it is known that he was not in the habit of sleeping in this manner before he was taken ill, the inference is warranted either that he is delirious or that he is suffering from pain in the lower part of his abdomen. Finally, if the patient shows an inclination to maintain a sitting posture while the malady is still in an active stage, this feature must be looked upon as a grave symptom and especially so in inflammation of the lungs.

XIV. — Pus that has a whitish color and a uniform consistency, that is smooth and free from clumps, and the odor of which is only slightly unpleasant, is the least harmful. On the other hand, a pus which possesses the opposite characteristics is very dangerous.

XL. — Severe pain in the ear, if associated with a persistent fever is dangerous, for the patient may become delirious and die.

[There are 47 chapters in the Book of Prognoses; in addition, there are 740 separate sections in the Coan Prognoses {Praenotiones Coacae).]

The Epidemic Diseases. — ^VI. — 4. The wife of Agasis had already as a young girl been troubled with shortness of breath. After she had reached womanhood, and soon after she had given birth to a child, she lifted a heavy weight. Immediately she heard, as she believed, a noise in her chest, and on the following day she experienced some difficulty in breathing and a certain amount of pain in her right hip. These two symptoms were so related to each other that, whenever the pain in the hip made its appearance, she immediately became conscious that she was short of breath, and, vice versa, whenever the pain ceased, she found that her breathing became easier. Her expectoration was of a foamy character and of a rather bright color, but, after it had been allowed to stand for a short time, it looked like diluted biliary matter that had been vomited. The pain in the hip troubled her chiefly when she performed manual work. She was advised to

EXTRACTS FROM HIPPOCRATIC WRITINGS 93

abstain from eating garlic, pork, mutton, and beef, and not to call loudly or to get excited while she was engaged in work.

VII. — 7. The wife of Polycrates became feverish during the summer season, and about the time of the dog star. In the morning her breathing was somewhat embarrassed, but after mid-day it became more difficult and at the same time more rapid. From the very beginning of the illness she had a cough and expectorated purulent masses. In the throat and along the course of the trachea one could hear a hoarse whistling sound. The patient's face had a healthy color, and over the two halves of the jaw there was some redness, not of a deep hue but rather fresh and bright. A little later her voice also became hoarse, she began to show some emaciation, raw spots developed over the fleshy parts of her hips, and the surface of the body grew more moist than it had been before. On the seventieth day the outward evidences of fever became much less noticeable, but the respiration grew more rapid ; and from that day to the time of her death, five or six days later, she was obliged to remain in a sitting posture. Toward the end the tracheal rale grew louder, and dangerous sweats occurred, but the patient never lost her expression of intelligence.

Fractures. — II. — 9. In the human body the foot, like the hand, is composed of a number of small bones. As they are not easily broken it may safely be assumed, when such a case of fracture comes under observation, that some pointed or unusually heavy object had caused the lesion, and that the surrounding soft parts must necessarily have been injured at the same time. (Injuries of this nature will be discussed in a later section.) But if any part of this bony framework is pushed out of its natural position — whether this take place in one of the toes, or in one of the tarsal bones, it makes no difference — the dislocated part should be forced back into position in the manner recommended in section XXIV. In its essential features the treatment consists in the employment of wax plaster, compresses, and bandages, exactly the same as is done in the treatment of fractures of the long bones, but without splints. The same rules hold good with regard to the degree of pressure to be applied, and every third day the dressings should be renewed. On each occasion of such renewal the patient should be questioned with regard to the sensations which he feels after the bandages have been applied, and if necessary they should be readjusted in accordance with the nature of the answers which he gives. The great majority of these injuries heal completely in twenty days. The exceptional cases are those in which the fracture

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involves a bone that stands in immediate relation with the bones of the leg. It is advisable, however, that the patient should remain in bed during the period mentioned; for, in not a few instances, the persons thus affected, failing to appreciate the gravity of the injury, walk about before the parts have really healed; and then, for an indefinite period of time, they are frequently reminded in a painful manner of the injury which they received. There is nothing astonishing in this when the fact is recalled to mind that the feet support the entire weight of the body.

[Forty-eight chapters or sections, some of them of considerable length, are devoted to the subject of fractures. The authorities are almost unanimous in stating that this portion of the so-called Hippocratic writings was written by Hippocrates himself. Malgaigne and Petrequin, two of the most competent French writers on questions relating to surgery, declare that the treatises written by Hip- pocrates on fractures and dislocations (the two forming in reality one continuous treatise) are the best and most complete books ever written by a physician.]

Wounds of the Head. — 10. The physician should, first of all, before touching the patient's head, inspect carefully the wound and surrounding parts. After noting whether the injury has been inflicted upon a strong or a weak portion of the head, he should ascertain whether the hair has been cut by the fall or the blow, and whether portions of it have penetrated into the wound. In the latter event he should express his fear that the skull at this point has been laid bare and has perhaps even received some material injury. He should make this statement before he has touched or probed the wound. Then afterward he should proceed to a physical examination of the injured parts, in order that he may learn positively whether the overlying soft tissues have or have not been separated from the bone. If simple inspection reveals the fact that the skull has been laid bare, well and good; but, if the real condition is not thus revealed, he should not hesitate to employ the probe. If he finds that the soft parts have been separated from the bone and that the latter has been more or less injured, he should continue this more minute exploration until he shall have ascertained to just what extent and in what manner the skull has been injured, and what measures are required to remedy the damage ; in brief, he should make the diagnosis. At the

EXTRACTS FROM HIPPOCRATIC WRITINGS 95

same time, however, he should not neglect to question the patient very closely about the manner in which the wound was inflicted, for in this way he may be able to infer the existence of a contusion, or even a fracture of the skull, of which no material evidences are discoverable. Important information may also be gathered by passing the hand over the seat of injury in the bone, — information which the employment of the probe is not competent to convey,

[Twenty-one additional chapters are devoted to wounds of the head, every possible phase of the subject being handled by Hippocrates in the most careful and thorough manner.]

CHAPTER IX

THE STATE OF GREEK MEDICINE AFTER THE EVENTS OF THE PELOPONNESIAN WAR; THE FOUNDING OF ALEXANDRIA IN EGYPT, AT THE MOUTH OF THE NILE ; AND THE DEVELOP- MENT OF DIFFERENT SECTS IN MEDICINE

Up to the time when war broke out between Sparta and Athens (431 B. C), the latter city had for many years easily held the supremacy, not merely in everything relating to the science and art of medicine, but also in all other branches of learning and especially in the arts of sculpture, painting and architecture. At the time named above came the beginning of her downfall. For a period of about twenty-one years she struggled against disasters of all sorts.

The Plague at Athens, the first Recorded in History. — Shortly after the war began — a war engendered by the bitter jealousy of Sparta over the ever increasing ascend- ancy of her rival — the latter city was visited by a devas- tating plague, the first European pestilence that has been recorded in history. Thucydides, who wrote the history of the Peloponnesian War, gives a most lucid description of this plague of Athens, from which I shall copy certain portions.

It first began, it is said, in the parts of Ethiopia above Egypt, and thence descended into Egypt and Libya and into most of the King's country. Suddenly falling upon Athens, it first attacked the population in Piraeus, — which was the occasion of their saying that the Peloponnesians had poisoned the reservoirs, there being as yet no wells there, — and afterward appeared in the upper city, when the deaths became much more frequent. All speculation

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as to its origin and its causes, if causes can be found adequate to produce so great a disturbance, I leave to other writers, whether lay or professional ; for myself, I shall simply set down its nature, and explain the symptoms by which perhaps it may be recognized by the student, if it should ever break out again. This I can the better do, as I had the disease myself, and watched its op